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FAQ describing the Banff criteria on HDCN ) and the unpublished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)