Abstract
The Expanded Criteria Donor (ECD) recommends histological evaluation of the kidney not only for donors over 60 but also for donors over 50 with comorbidities (firstly hypertension) even in the setting of normal serum creatinine [1]. The histological parameters to be evaluated include glomerular, vascular, tubular and interstitial injury. However, no studies have provided an absolute threshold beyond which a donor kidney must not be used, and there is no consensus on the value of biopsies for predicting graft function. Histological evaluation of the donor biopsy can be performed at harvesting by on call pathological examination or by means of implantation biopsies. Tissue sample analysis of implantation biopsies includes the immunohistochemistry (IHC) evaluation of C4d to identify pre-sensitized patients and immunofluorescence to highlight misdiagnosed glomerular diseases. The biopsies can be obtained through a wedge resection or needle core biopsy: superficial sampling in wedge resections can overestimate the glomerular sclerosis and fibrosis because the outer cortex is more sensitive to ischaemic damage (Fig. 21.1). Adequate sampling must contain at least 25 glomeruli and 2 arteries.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Haas M. Donor kidney biopsies: pathology matters, and so does the pathologist. Kidney Int. 2014;85:1016–9.
Pokorná E, Vítko S, Chadimová M, Schück O, Ekberg H. Proportion of glomerulosclerosis in procurement wedge renal biopsy cannot alone discriminate for acceptance of marginal donors. Transplantation. 2000;69:36–43.
Mizuiri S, Shigetomi Y, Sugiyama K, Miyagi M, Hatano T, Tajima E, Aikawa A, Ohara T, Kawamura S, Hasegawa A. Successful transplantation of a cadaveric kidney with post-infectious glomerulonephritis. Pediatr Transplant. 2000;4:56–9.
Randhawa PS, Minervini MI, Lombardero M, Duquesnoy R, Fung J, Shapiro R, Jordan M, Vivas C, Scantlebury V, Demetris A. Biopsy of marginal donor kidneys: correlation of histologic findings with graft dysfunction. Transplantation. 2000;69:1352–7.
McCall SJ, Tuttle-Newhall JE, Howell DN, Fields TA. Prognostic significance of microvascular thrombosis in donor kidney allograft biopsies. Transplantation. 2003;75:1847–52.
Bennett WM, Hansen KS, Houghton DC, McEvoy KM. Disseminated intravascular coagulation (DIC) in a kidney donor associated with transient recipient DIC. Am J Transplant. 2005;5:412–4.
Alexander JW. High-risk donors: diabetics, the elderly, and others. Transplant Proc. 1992;24:2221–2.
Ojo AO, Leichtman AB, Punch JD, Hanson JA, Dickinson DM, Wolfe RA, Port FK, Agodoa LY. Impact of pre-existing donor hypertension and diabetes mellitus on cadaveric renal transplant outcomes. Am J Kidney Dis. 2000;36:153–9.
Becker YT, Leverson GE, D’Alessandro AM, Sollinger HW, Becker BN. Diabetic kidneys can safely expand the donor pool. Transplantation. 2002;74:141–5.
Taub HC, Greenstein SM, Lerner SE, Schechner R, Tellis VA. Reassessment of the value of post-vascularization biopsy performed at renal transplantation: the effects of arteriosclerosis. J Urol. 1994;151:575–7.
Oda A, Morozumi K, Uchida K. Histological factors of 1-h biopsy influencing the delayed renal function and outcome in cadaveric renal allografts. Clin Transplant. 1999;13 Suppl 1:6–12.
Karpinski J, Lajoie G, Cattran D, Fenton S, Zaltzman J, Cardella C, Cole E. Outcome of kidney transplantation from high-risk donors is determined by both structure and function. Transplantation. 1999;67:1162–7.
Pliquett RU, Asbe-Vollkopf A, Scheuermann EH, Gröne E, Probst M, Geiger H, Hauser IA. Cholesterol-crystal embolism presenting with delayed graft function and impaired long-term function in renal transplant recipients: two case reports. J Med Case Rep. 2009;3:6839. doi:10.1186/1752-1947-3-6839.
Remuzzi G, Cravedi P, Perna A, Dimitrov BD, Turturro M, Locatelli G, Rigotti P, Baldan N, Beatini M, Valente U, Scalamogna M, Ruggenenti P, Dual Kidney Transplant Group. Long-term outcome of renal transplantation from older donors. N Engl J Med. 2006;354:343–52.
Haas M, Sis B, Racusen LC, Solez K, Glotz D, Colvin RB, Castro MC, David DS, David-Neto E, Bagnasco SM, Cendales LC, Cornell LD, Demetris AJ, Drachenberg CB, Farver CF, Farris 3rd AB, Gibson IW, Kraus E, Liapis H, Loupy A, Nickeleit V, Randhawa P, Rodriguez ER, Rush D, Smith RN, Tan CD, Wallace WD, Mengel M. Banff meeting report writing committee. Banff 2013 meeting report: inclusion of c4d-negative antibody-mediated rejection and antibody-associated arterial lesions. Am J Transplant. 2014;14:272–83. doi:10.1111/ajt.12590.
Sis B, Mengel M, Haas M, Colvin RB, Halloran PF, Racusen LC, Solez K, Baldwin 3rd WM, Bracamonte ER, Broecker V, Cosio F, Demetris AJ, Drachenberg C, Einecke G, Gloor J, Glotz D, Kraus E, Legendre C, Liapis H, Mannon RB, Nankivell BJ, Nickeleit V, Papadimitriou JC, Randhawa P, Regele H, Renaudin K, Rodriguez ER, Seron D, Seshan S, Suthanthiran M, Wasowska BA, Zachary A, Zeevi A. Banff’09 meeting report: antibody mediated graft deterioration and implementation of Banff working groups. Am J Transplant. 2010;10:464–71. doi:10.1111/j.1600-6143.2009.02987.x.
Haas M, Ratner LE, Montgomery RA. C4d staining of perioperative renal transplant biopsies. Transplantation. 2002;74:711–7.
Jennette JC, Heptinstall RH. Heptinstall’s pathology of the kidney. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2007.
Nankivell BJ, Borrows RJ, Fung CL, O’Connell PJ, Chapman JR, Allen RD. Calcineurin inhibitor nephrotoxicity: longitudinal assessment by protocol histology. Transplantation. 2004;78:557–65.
Sis B, Dadras F, Khoshjou F, Cockfield S, Mihatsch MJ, Solez K. Reproducibility studies on arteriolar hyaline thickening scoring in calcineurin inhibitor-treated renal allograft recipients. Am J Transplant. 2006;6:1444–50.
Boubenider S, Hiesse C, Goupy C, Kriaa F, Marchand S, Charpentier B. Incidence and consequences of post-transplantation lymphoproliferative disorders. J Nephrol. 1997;10:136–45.
Feng S, Buell JF, Chari RS, DiMaio JM, Hanto DW. Tumors and transplantation: the 2003 third annual ASTS state-of-the-art winter symposium. Am J Transplant. 2003;3:1481–7.
WHO. Classification of tumours of haematopoietic and lymphoid tissues. 4th ed. Lyon: IARC Press; 2008.
Rungta R, Ray DS, Das P, Gupta S. Three different opportunistic infections in the same renal allograft recipient at the same time: unusual case report. Trop J Med Res. 2014;17:45–7.
Weikert BC, Blumberg EA. Viral infection after renal transplantation: surveillance and management. Clin J Am Soc Nephrol. 2008;3 Suppl 2:S76–86. doi:10.2215/CJN.02900707.
Brennan DC. Cytomegalovirus in renal transplantation. J Am Soc Nephrol. 2001;12:848–55.
Freeman Jr RB. The ‘indirect’ effects of cytomegalovirus infection. Am J Transplant. 2009;9:2453–8. doi:10.1111/j.1600-6143.2009.02824.x.
Hariharan S. BK virus nephritis after renal transplantation. Kidney Int. 2006;69:655–62.
Parasuraman R, Zhang PL, Samarapungavan D, Rocher L, Koffron A. Severe necrotizing adenovirus tubulointerstitial nephritis in a kidney transplant recipient. Case Rep Transplant. 2013;2013:969186. doi:10.1155/2013/969186.
Florescu MC, Miles CD, Florescu DF. What do we know about adenovirus in renal transplantation? Nephrol Dial Transplant. 2013;28:2003–10. doi:10.1093/ndt/gft036.
Raghavan R, Eknoyan G. Acute interstitial nephritis – a reappraisal and update. Clin Nephrol. 2014;82:149–62.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Malvi, D., Rosini, F., D’Errico, A. (2015). Kidney. In: Pinna, A., Ercolani, G. (eds) Abdominal Solid Organ Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-16997-2_21
Download citation
DOI: https://doi.org/10.1007/978-3-319-16997-2_21
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-16996-5
Online ISBN: 978-3-319-16997-2
eBook Packages: MedicineMedicine (R0)