We need to establish an informative guideline to increase inter-institutional and inter-observer reproducibility of renal transplant diagnosis, and to improve the diagnostic ability of pathologists in Korea. A first nation-wide survey for renal transplant pathology was conducted by Renal Pathology Study Group of the Korean Society of Pathologists in 2016, to provide the continued excellence in the transplantation pathology laboratory, and to improve the diagnostic ability for the best treatment of transplant patients. This survey revealed the significant variations in scale, work load and biopsy indications for the renal transplant pathology in various institutions in Korea. The Banff classification were used by all institutions for the diagnosis of renal transplant pathology, but different formats were used: most institutions (70%) used the “2013 Banff classification” while the others were using “2007 Banff classification” (20%) or even older formats. In daily diagnostic practice of the renal allografts, difficulties that pathologists encounter were quite diverse due to different environments they work in. Most respondents agreed that standardized diagnostic practice guidelines, regular education on renal transplant pathology and convenient ways of consultation are further needed. We are currently working toward the enhancement of the expertise of renal pathologists and to increase inter-institutional and inter-observer reproducibility by 1) development of a set of virtual slides of renal allograft biopsies for the training, 2) validation and gathering expert's consensus on the core variables of rejection diagnosis by using virtual slides, and 3) continued education by the developed virtual slide atlas.
Allografts ; Biopsy ; Classification ; Consensus ; Diagnosis ; Education ; Humans ; Kidney ; Korea* ; Pathology* ; Surveys and Questionnaires ; Transplantation

1) The effectiveness of azathioprine (Imuran) in suppressing the immunogenic rejection of corneal grafts was studied by pathology. 2) The method of conjunctival implantation was used to produce neovascularization of the host cornea and the rejection of interlamellar allgraft and xenograft (rooster to rabbit) provided the experimental model against which the therapeutic efficacy of the drug was evaluated. There is almost same pathological finding between interlamellar homograft and heterograft. but the rejection phenomena of the heterograft group is slightly severer than homograft group. 3) On comparing the graft rejection between control and treated group in homograft and heterograft, the reaction in control group is severer than treated group. Microscopically, tbe cornea of treated group is almost transparent, but there are fibrosis of graft border, thickening of the host tissues and irregular arragement of corneal lamellae, by microscopically 4) On comparing between sensitized and non-sensitized group, no specific difference was observed by microspically.
Allografts ; Azathioprine* ; Cornea ; Fibrosis ; Graft Rejection ; Heterografts ; Immunosuppression* ; Models, Theoretical ; Pathology ; Transplants*

Transplant glomerulopathy (TG) is a special form of glomerular injury in renal allografts. It affects varying proportions of glomeruli, which may have an influence on the amount of proteinuria or graft survival. We reviewed 32 cases of TG to evaluate histologic changes and graft outcome. The severity of TG as well as acute and chronic changes of the glomerular, tubulointerstitial and vascular compartment were scored according to Banff classification. There were 17 cases of cg1, 3 cases of cg2 and 12 cases of cg3. There was no significant difference in age, duration of transplant at time of biopsy and duration of follow-up between groups. Serum creatinine level and the degree of proteinuria were higher in cg3 and statistically significant. However, there was no difference in the degree of glomerulosclerosis, interstitial inflammation, fibrosis, tubular atrophy or vascular wall thickening between groups. Graft failure was present in 13 cases, mostly due to chronic rejection including sepsis and CMV infection in one case each. Five-year graft survival was 84.1% and was not significantly different from cases without TG. In conclusion, the severity of TG indicates profuse proteinuria, but does not affect graft outcome, which indicates tubulointerstitial and vascular pathology as being a more important prognosticator.
Allografts ; Atrophy ; Biopsy ; Classification ; Creatinine ; Fibrosis ; Follow-Up Studies ; Graft Survival* ; Inflammation ; Pathology ; Proteinuria* ; Sepsis ; Transplants*

Collapsing glomerulopathy (CG) is a recently described form of focal segmental glomerulosclerosis (FSGS) which was defined by renal pathology findings. CG is characterized by severe proteinuria and rapid progressive decline of renal function clinically. We experienced one case of CG in renal allograft. 24 year-old male recipient was admitted for evaluation of proteinuria (5.08 g/day) and increment of serum creatinine level at post-transplant 150 days. The graft biopsy was taken and the pathology specimen demonstrated a typical characteristics of CG such as glomerular capillary collapse, visceral epithelial hypercellularity, deposition of immunoglobulin/C3 and variable degree of tubulointerstitial injury. The patient was negative for HIV infection before transplantation and at the time of biopsy diagnosis. No specific treatment for CG was performed. The patient progressed to the graft failure and returned to hemodialysis 84 days after biopsy. In conclusion, recognition of CG by graft biopsy is important because it is a lesion with a high risk for rapid progression to graft failure.
Allografts* ; Biopsy ; Capillaries ; Creatinine ; Diagnosis ; Glomerulosclerosis, Focal Segmental ; HIV Infections ; Humans ; Male ; Pathology ; Proteinuria ; Renal Dialysis ; Transplants ; Young Adult

Even with improved immunosuppressive therapies, graft rejection remains the major cause of failure. Renal biopsy is the most sensitive tool and gold standard for the diagnosis of rejection and other causes of graft dysfunction. Because of the large number of conditions that can affect the allograft, sometimes in combination, renal transplantation pathology is one of the most challenging areas for the renal pathologist. The major causes of allograft dysfunction include rejection, postoperative acute tubular necrosis, perfusion injury, drug toxicity, obstruction, major vascular occlusion, infection, allergic interstitial nephritis, recurrent or de novo glomerular disease, and post-transplant lymphoproliferative disease. The criteria for grading rejection by the Banff 97 schema and the new concept of acute antibody-mediated rejection are introduced.
Allografts ; Biopsy ; Diagnosis ; Drug-Related Side Effects and Adverse Reactions ; Graft Rejection ; Kidney Transplantation* ; Necrosis ; Nephritis, Interstitial ; Pathology* ; Perfusion ; Transplants

STUDY DESIGN: Ninty eight patients with multilevel spinal stenosis who were treated with posterior decompression and instrumented posterolateral fusion were reviewed retrospectively. All patients were divided two groups by pathologic level and surgery level. One is complete level decompression group (whole pathologic levels were decompressed) and the other is limited level decompression group (less than pathologic levels were decompressed). SUMMARY OF BACKGROUND DATA: Many patients with spinal stenosis haute multilevel pathology, which is very difficult problem to make surgical strategy for determination of decompression level. METHOD: Patients were reviewed using combination of clinical records, follow-up examinations and radiographs. Posterior decompression and instrumented posterolateral fusion were performed in all patients using pedicle screw fixation (TSRH 49 cases, Diapason 37 cases, CCD 12 cases) and either autogenous bone graft alone or autograft with allograft. The average follow-up period was 19.7 months. RESULTS: In the clinical results by the criteria of Kirkalldy-Willis, there was no difference between complete level decompression group and limited level decompression group. By the bone graft mothorts, fusion rate was no difference between autograft alone group and autograft with allograft group, but fusion periods were more shorter in autograft alone group than in autograft with allograft group(P>0.05). CONCLUSION: In multilevel spinal stenosis, the segments that associated with neurologic symptoms or seyeie stenosis on radiograph must be decompressed but the segments that not associated with neurologic symptoms and mild stenosis on radiograph do not need preventive decompression.
Allografts ; Autografts ; Constriction, Pathologic ; Decompression ; Follow-Up Studies ; Humans ; Neurologic Manifestations ; Pathology ; Retrospective Studies ; Spinal Stenosis* ; Transplants*

OBJECTIVE: To investigate the role of connective tissue growth factor (CTGF) in pulmonary allograft fibrosis in rats. METHODS: The lungs of 20 Wistar rats were transplanted into 20 Sprague-Dawley(SD) rats. Ten allograft lungs were harvested 1 week postoperatively (acute rejection group,AR); the other 10 allografts were harvested 6 weeks postoperatively (chronic rejection group,CR); and ten normal Wistar rats served as a control group(normal lung, NL). Paraffin embedded sections of the harvested lung specimens were stained with hematoxylin and eosin (HE), Van Gieson (VG) for the examination of tissue morphology under the microscope. The scores of lung fibrosis were measured and the wet/dry ratio of the lung specimens was evaluated. The CTGF expression was determined by immunohistochemical method. RESULTS: The wet/dry ratios of lung decreased gradually(AR group vs. control group: 3.48+/-0.47 vs. 4.67+/-0.51, P<0.05; CR group vs. AR group: 2.85+/-0.52 vs. 3.48+/-0.47, P<0.05). The transplanted lungs showed massive lymphocytic infiltration, interstitial fibrosis, destroyed alveolus architecture, obliterative bronchiolitis, and lung tissue consolidation. These pathological changes were more severe in the CR group than in the AR group, but there were no such changes in the control group (scores of pulmonary fibrosis: NH, 0.00+/-0.00; AR, 0.98+/-0.47; CR, 2.35+/-0.52; AR vs. NH, P<0.01; CR vs. AR, P<0.01). CTGF was not expressed in the normal rat lungs (0.00+/-0.00); however, it was detected in the lung allograft after the operation. The CTGF expression in the CR group was significantly higher than that in the AR group (P<0.01). CONCLUSION The expression of CTGF protein is related to the transplanted pulmonary fibrosis,and is involved in the pathogenesis of transplanted pulmonary fibrosis.
Allografts ; pathology ; Animals ; Connective Tissue Growth Factor ; metabolism ; Fibrosis ; Lung ; metabolism ; pathology ; Lung Transplantation ; Male ; Pulmonary Fibrosis ; metabolism ; Rats ; Rats, Sprague-Dawley ; Rats, Wistar

PURPOSE: To evaluate the pathology of prospective kidney donors and assess the clinical outcomes of the renal allografts. METHODS: We reviewed the records of 12 prospective kidney donors who underwent kidney biopsy. The indications of kidney biopsy were asymptomatic microscopic hematuria (n=88, 66.7%), decreased glomerular filtration rate (GFR, n=22, 16.7%), mild proteinuria (n=11, 8.3%), history of gross hematuria (n=11, 8.3%). RESULTS: Kidney biopsy in 8 prospective donors with asymptomatic microscopic hematuria showed: 5 (62.5%) thin basement membrane disease (TBMD); 1 IgA nephropathy; 1 Alport's syndrome; 1 mild mesangial widening. Two prospective donors with decreased GFR showed IgA nephropathy and tubulointerstitial lesion. The one with mild proteinuria showed arterionephrosclerosis and the one with a history of gross hematuria showed tubulointerstitial lesion. 4 (33.3%) of the 12 who underwent kidney biopsy were accepted as kidney donors.; 3 donors with TBMD and the donor with mild mesangial widening, who all had microscopic hematuria. Among the 4 donations, there was 1 graft failure and 3 allografts (1 mild mesangial widening, 2 TBMD) have maintained graft function at latest follow up. CONCLUSION: The most common cause of asymptomatic microscopic hematuria in prospective kidney donors was TBMD. Long-term follow up is needed to assess the clinical outcomes of these allografts.
Allografts* ; Basement Membrane ; Biopsy* ; Follow-Up Studies ; Glomerular Filtration Rate ; Glomerulonephritis, IGA ; Hematuria ; Humans ; Kidney* ; Nephritis, Hereditary ; Pathology ; Prospective Studies* ; Proteinuria ; Tissue Donors* ; Transplants

Circulating alloantibodies are found in a substantial number of renal allograft recipients, and can induce chronic allograft injury, which is represented microscopically as transplant glomerulopathy and diffuse C4d deposition in peritubular capillaries (PTCs). Development of these injuries is significantly correlated with late allograft loss, and in this regard, it was included as a new disease entity named chronic antibody-mediated rejection (cAMR) in the updated Banff 05 classification. Usually, the prognosis of cAMR is poor and conventional immunosuppressants mainly targeting T cell-mediated immunity cannot prevent or reverse it. Therefore, some researchers have suggested that therapies directed at the humoral response may be required for the treatment of cAMR. Recently, some reports have suggested that the combined use of rituximab and intravenous immunoglobulin (IVIg) therapy may be useful for the treatment of cAMR. Our previous study also showed that rituximab and IVIg combination therapy effectively delayed the progression of cAMR. We administered rituximab and IVIg combination therapy to 18 biopsy-proven cAMR patients and found that it significantly slowed the decline of the estimated glomerular filtration rate. However, this effect was limited in patients with heavy proteinuria, and dissipated in all patients by 1 year post-treatment. Recently, new drugs targeting the humoral immune system, such as bortezomib and eculizumab, have been tested for the treatment of cAMR. However, the studies still lack definitive data in terms of successful treatment of cAMR. We speculate that those therapies will compensate for the limitation of previous anti-humoral therapies for cAMR.
Allografts ; Capillaries ; Classification ; Glomerular Filtration Rate ; Humans ; Immune System ; Immunity, Cellular ; Immunoglobulins ; Immunoglobulins, Intravenous ; Immunosuppressive Agents ; Isoantibodies ; Kidney Transplantation* ; Pathology ; Prognosis ; Proteinuria ; Bortezomib ; Rituximab

BACKGROUND: Previous studies reported a poor prognosis in patients with persistent proteinuria later in the posttransplantation course, suggesting that posttransplantation proteinuria is a marker for graft failure. This study was undertaken to elucidate the role of proteinuria after renal transplantation in the pathogenesis and outcome of allograft dysfunction in transplant biopsy-proven recipients. METHODS: We retrospectively analyzed the data from 55 patients who underwent transplant renal biopsy for proteinuria and/or azotemia occurring beyond 1 year after transplantation. Proteinuria was considered as significant when >or=30 mg/dL, and the results of transplant biopsy were categorized according to the Banff 97 classification. Logistic regression was used to estimate odds ratios (OR) for graft loss associated with proteinuria and transplant pathology. RESULTS: The patients were followed for 86.0 +/- 32.8 (mean +/- SD) months after transplantation, and transplant biopsy was performed at 54.1 +/- 31.0 months. Proteinuria at 1 year after transplantation was noted in 29.1% of the patients, and it was not significantly associated with graft loss (OR=1.94, 95% CI 0.59-6.41). In addition, proteinuria at the time of transplant biopsy was not significantly associated with graft loss, and none of each category of transplant pathology was significantly associated with graft loss. Chronic allograft nephropathy was the most frequent transplant pathology, and only glomerulonephritis was significantly associated with proteinuria at the time of transplant biopsy. On the other hand, graft loss was significantly associated with the presence of proteinuria both at 1 year after transplant biopsy and at the final follow-up. CONCLUSION: These results suggest that posttransplantation proteinuria is an important marker of graft dysfunction but may not be predictive of graft loss in biopsy-proven cases. Appropriate management guided by the results of transplant biopsy may improve the outcome.
Allografts* ; Azotemia ; Biopsy ; Classification ; Follow-Up Studies ; Glomerulonephritis ; Hand ; Humans ; Kidney Transplantation ; Kidney* ; Logistic Models ; Odds Ratio ; Pathology ; Prognosis ; Proteinuria* ; Retrospective Studies ; Transplants