title: Transplant nephrectomy: histologic findings—a single center study.
abstract: OBJECTIVE
  To identify the histopathological features of transplant nephrectomy (TN) specimens.
  
  
  METHODS
  We performed retrospective analysis of 73 nephrectomies to review the histopathology in detail and correlate the Banff grading characteristics of TN specimens with time post engraftment and clinical features. Retrospective data on donor-specific antibodies (DSA) were also collected.
  
  
  RESULTS
  The majority of patients who had TN in less than 3 months posttransplant (n = 20; median time to TN: 4 days) had hemorrhagic infarction; 7 patients (35%) had grade 3 acute rejection (AR). Patients who had TN later than 3 months posttransplant (n = 53; median time to TN: 67 months) had AR, grade 2B (21%) and 3 (43%), coexisting with advanced vascular injury in the form of interstitial hemorrhage, extensive interstitial fibrosis and tubular atrophy (IF/TA) as well as the presence of DSAs. Overall, the majority of patients without DSA pre-TN developed DSA post-TN.
  
  
  CONCLUSIONS
  Our data revealed extensive inflammation and ongoing immunologic activity in a subset of patients with a failed graft. Careful and individualized approach based on clinical and laboratory data should guide the decision for transplant nephrectomy.
authors.affiliation: Hospital of the University of Pennsylvania, Department of Medicine, Renal, Electrolyte, and Hypertension Division, Philadelphia, Pa., USA.
authors.forename: Simin
authors.initials: S
authors.lastname: Goral
authors.forename: Kirsten
authors.initials: K
authors.lastname: Brukamp
authors.forename: Erin H
authors.initials: EH
authors.lastname: Ticehurst
authors.forename: Peter L
authors.initials: PL
authors.lastname: Abt
authors.forename: Roy D
authors.initials: RD
authors.lastname: Bloom
authors.forename: Jane
authors.initials: J
authors.lastname: Kearns
authors.forename: Serban
authors.initials: S
authors.lastname: Constantinescu
authors.forename: Malek
authors.initials: M
authors.lastname: Kamoun
authors.forename: John
authors.initials: J
authors.lastname: Tomaszewski
mesh_terms: D000328:Adult; D000906:Antibodies / Q000276:immunology; D015331:Cohort Studies; D005260:Female; D005355:Fibrosis; D006084:Graft Rejection / Q000276:immunology / Q000473:pathology*; D006680:HLA Antigens / Q000276:immunology; D006470:Hemorrhage / Q000473:pathology*; D006801:Humans; D007238:Infarction / Q000473:pathology*; D007668:Kidney / Q000098:blood supply / Q000276:immunology / Q000473:pathology*; D007674:Kidney Diseases / Q000276:immunology / Q000473:pathology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
chemical_list: D000906:Antibodies; D006680:HLA Antigens