To determine the spectrum of pathological changes in renal graft biopsies performed for evaluation of graft dysfunction in a live related renal transplant program.
A retrospective review of 1210 biopsies from 700 renal transplant patients was carried out. Two cores of graft biopsies are obtained under ultrasound guidance. Both are fixed in formalin and processed for light microscopy. One additional core was obtained for IMF and EM study in suspected cases of glomerulonephritides. The histological changes are classified according to Banff 1997 working classification of renal allograft pathology. A total of 1210 graft biopsies were performed in 700 patients. Acute rejection was seen in 292 (24%) cases, followed by acute tubular injury and CyA toxicity, found in 281 (23.2%) and 134 (11%) cases respectively. Chronic allograft nephropathy with variable degree of tubular atrophy was seen in 361 (29.8%) cases. Acute pyelonephritis was seen in 79 (6.5%) cases. Thirty (2.5%) cases of recurrent/denovo renal diseases were found. FSGS was the most common lesion found in 15 cases. Eight cases of IgA nephropathy were seen. Four cases of oxalosis were found. Two cases of MCGN and one case of Fabry’s disease were also noted. A number of rare lesions were found in 33 (2.7%) cases. The study defines the pattern of pathological lesions in a large cohort of live related renal transplant patients. The incidence of acute rejection is low in our patients as compared to Western studies and CyA toxicity is more common. Recurrent/denovo renal disease occurs in a significant minority of dysfunctional graft biopsies and among these, recurrent/denovo FSGS is the most common lesion.