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Currently filtering by tag: Transplant

Art of Medicine: The Pre-Implantation Kidney Biopsy

The painting above shows normal glomeruli, tubulointerstitium, and a normal artery from a pre-implantation wedge biopsy. Pre-implantation wedge biopsies, also known as donor biopsies, procurement biopsies, or harvest biopsies, are performed for extended criteria donor kidneys, high risk recovered donor kidneys, or at the request of the transplant surgeon, to evaluate for suitability for transplantation. Over 40% of procured kidneys are discarded prior to transplantation. The use of preimplantation kidney biopsies, performed as frozen sections at transplant centers, may reduce the discard rate by accepting kidneys that are histopathologically acceptable, as well as to avoid transplantation of sub-optimal organs. “Extended...

Twitter Poll (June 26, 2019)

ANSWER: C Severe intimal arteritis (v2), with or without interstitial inflammation and/or tubulitis is considered acute TCMR Grade IIB based on the Banff 2017 classification. However, we now know that arterial lesions (v>0) may be indicative of ABMR, TCMR or mixed ABMR/TCMR and are not restricted to TCMR. Reference: Haas M, et al. The Banff 2017 Kidney Meeting Report: Revised diagnostic criteria for chronic active T-cell mediated rejection, antibody-mediated rejection, and prospects for integrative endpoints for next-generation clinical trials. Am J Transplant. 2018; 1-15.    

Membranous Nephropathy After Transplantation

The biopsy shows a recurrent membranous nephropathy within a transplant. Figure 1 shows "spikes" and "holes." Figure 2 shows mild interstitial fibrosis. Figures 3, 4, 5, and 6 shows IgG, kappa, lambda, and PLA2r, respectively. Figure 7 shows subepithelial and intramembranous deposits. Membranous nephropathy can arise in the graft from recurrence of the original disease, a de novo disease, and rarely as a donor-derived disease. Recurrence of the original disease can be seen as early as one week post transplant. Most cases of recurrent membranous nephropathy occur within the first few months following transplantation, whereas de novo membranous nephropathy usually...

Pushing Glass (December 7, 2018)

The patient is a 50-year-old female who presents 2 days after a renal transplant with a delay in graft function and a creatinine of 7. Her end-stage renal disease was due to diabetic glomerulopathy. She was on dialysis for 3 years. She received a kidney from a 22-year-old deceased donor (motorcycle accident). The kidney at time of transplant looked normal grossly and microscopically. What is the most likely cause of the patient’s delay in graft function? A. Acute Cellular Rejection B. Surgical manipulation of a vessel C. Recurrent diabetes D. Donor-derived disease   The correct answer is (B) surgical manipulation...