CLINICAL SIGNIFICANCE OF THE 1-HOUR BIOPSY IN RENAL TRANSPLANTATION

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Abstract
Biopsy specimens were obtained from 43 transplanted kidneys at the time of excision from the donor but prior to revascularization, and 1 hr after revascularization. Two independent laboratories evaluated specimens by immunofluores-cent techniques for the presence of IgM, IgA, IgG, C'3, and fibrin. Results from the two laboratories were examined for reproducibility and immunological specificity, and correlated with clinical course. Results show that immunoglobulin deposition seen in the 1-hr renal biopsy specimens is of little significance, because: (1) immunoglobulin deposition was difficult to quantitate reliably, (2) the presence of immunoglobulins did not correlate with clinical course, and (3) the majority of immunoglobulin deposition detected was not immunologically specific, since it was most often either present prior to vascularization or disappeared with vascularization. The morphological changes that are associated with renal allograft rejection are well documented (3, 8, 10, 13). Immuno-fluorescent and electron microscopic techniques have shown that both accelerated and chronic rejections are characterized by immunoglobulin deposition (especially IgG), as well as complement (C'3) and fibrin deposition and polymorphonuclear infiltration of vessels and glomeruli (12). The use of the 1-hr postvascularization renal biopsy as an index for both the prognosis and diagnosis of allograft rejection is based on the assumption that these histopathological changes can be quantitatively and qualitatively assessed at 1-hr post-transplantation, and that they are immunologically specific. It was the objective of this investigation to test these basic assumptions in order to evaluate the significance of the 1-hr biopsy in renal transplantation.

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