The impact of pathological diagnosis and histological damage in indicated biopsy on predicting long-term graft survival in renal transplant patients

Purpose: The relative impact of histological diagnoses and changes on renal allograft outcome remains elusive. To investigate the relative effects of histopathological lesions on graft kidney survival. Methods: In a single-center observational study, we examined the histopathological findings of allograft biopsies in kidney transplant recipients who achieved either a doubling of the creatinine level or graft failure. Results: The three most common biopsy diagnoses were Borderline acute cellular rejection (18.95%), mixed rejection (16.53%), and calcineurin inhibitor toxicity (15.73%). Similarly, transplant glomerulopathy with microvascular injury (88.89%) and microvascular injury alone (75%) were the most common clinical diagnoses achieving the graft endpoint. Conversely, calcineurin inhibitor toxicity had the lowest percentage of reaching the endpoint (20.51%). Finally, a strong association between chronicity score in histology and graft loss ratio has been noted using Kaplan–Meier estimates in this study. Conclusion: Microvascular injury and transplant glomerulopathy, two distinctive histological indicators of antibody-mediated rejection (ABMR), have a dramatic impact on graft renal loss. The impact of CNI toxicity on long-term graft survival was also overemphasized as it did not cause as much graft failure. Better diagnostic, monitoring, and therapeutic strategies for ABMR should be evolved to minimize graft renal loss.