Nephrol Dial Transplant (2003) 18: 655-660
© 2003 European Renal Association-European Dialysis and Transplant Association
Invited Comment
Transplant capillaropathy and transplant glomerulopathy: ultrastructural markers of chronic renal allograft rejection
Department of Pathology, University of Szeged, Szeged, Hungary
Keywords: chronic allograft nephropathy; chronic rejection; electron microscopy; kidney allograft; transplant capillaropathy; transplant glomerulopathy
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Introduction
A late dysfunction of a renal allograft refers to a progressive decline in renal function manifested >3 months after transplantation. A late dysfunction may have several causes, such as chronic rejection, chronic allograft nephropathy, chronic calcineurin inhibitor toxicity, de novo or recurrent renal disease and acute rejection. An allograft biopsy is necessary to establish a definitive diagnosis. The standard interpretation of alterations is widely carried out on the basis of the ‘Banff 97 classification’, which relies on the evaluation of light microscopic stains [1]. The assessment of allograft biopsies by light microscopy per se, however, is hampered by the fact that the histological examination of the specimen is not sufficient to identify all types of rejection. Whereas acute cellular rejection can be appropriately diagnosed, the recognition of chronic rejection seems impossible in a certain number of cases involving chronic rejection, and the verification of an alloantibody-mediated graft
Chronic rejection, chronic allograft nephropathy and allograft sclerosis
Limitations in the histological diagnosis of chronic rejection
Ultrastructural markers of chronic rejection
Transplant capillaropathy
Transplant glomerulopathy (Figure 5
)
Electron microscopy in the diagnosis of chronic rejection: a biopsy review
Comment