Percutaneous needle biopsies of renal allografts: the relationship between morphological changes present in biopsies and subsequent allograft function

Abstract

Percutaneous needle biopsies of renal transplants have been extensively used to help identify the cause of impaired allograft function. Of 269 renal allografts transplanted 154 were biopsied at least once during the first 90 days after transplantation. The relationship between morphological changes in these biopsy specimens and allograft function 1, 3 and 5 yr after transplantation is assessed. A highly significant direct relationship exists between early graft failure and the presence of medial necrosis of arteries, acute glomerular lesions and interstitial hemorrhage. Less than 10% of grafts with 1 or more of these changes and none in which all 3 types of lesion were present were capable of supporting life at 1 yr. There is a significant association between poor subsequent graft function and mononuclear cell infiltration of the intima of arteries. No clear relationship exists between the function of grafts at 1 and 3 yr and the degree of mononuclear cell infiltration of the interstitial tissue. Tubular necrosis is frequently observed and future graft performance is related to the extent and cause of the tubular damage.