HDCN Article Review/Hyperlink

Colvin RB

Nephrology Forum: The renal allograft biopsy

Kidney Int (Sep) 50:1069-1081 1996

Dr. Robert Colvin, one of the 28 authors on the original Banff Classification paper (Kidney International 44:411-422, 1993), has written an excellent review on the renal allograft biopsy. A patient is presented with biopsies demonstrating donor vascular disease, cyclosporine toxicity, and recurrent diabetic nephropathy.

Classifications are discussed including the Banff Schema (see the report of the Third Banff Conference and the FAQ describing the Banff criteria on HDCN ) and the unpublished modification of it used in the eight-center NIH-Cooperative Clinical Trials in Transplantation.

T-cell mediated rejection is discussed as well as late-appearing antibody-mediated rejection, recently more fully described by Trpkov et al. in the June 15th issue of Transplantation 61(11):1582-1592, 1996 . Viral processes which simulate acute allograft rejection are also described as well as post-transplant lymphoproliferative disorder. The significance of subclinical rejection is also discussed. Other important subjects considered include chronic allograft rejection, de novo glomerulonephritis, recurrent renal disease, cyclosporine A toxicity, sampling error, and alternative diagnostic techniques.

Comment: This is an excellent review of an important subject. It also provides evidence how fast moving developments are in this area. Based on presentations at the just-completed Barcelona Congress of the Transplantation Society, the little-used CCTT scoring system mentioned in the article appears to actually be more complex (involving assessment of twice the number of lesions for acute rejection diagnosis) and no more accurate or reproducible than the standard Banff classification. In other respects, however, this is one of the best succinct reviews of the subject that has appeared for some time - not surprising from an author who has consistently been responsible for some of the best scholarly work in the field. (Kim Solez, M.D., University of Alberta, Canada)