Study of the Spectrum of Pathological Findings in Renal Transplant Recipients with an Asymptomatic Slow Rise in Serum Creatinine at a Tertiary Care Centre in North India

Background: Chronic allograft dysfunction, characterized by a progressive increase in serum creatinine levels after kidney transplantation, poses a significant challenge in renal transplant recipients.

Aim: This study aimed to assess the spectrum of pathological findings in renal transplant recipients with an asymptomatic slow rise in serum creatinine.

Methodology: A hospital-based cross-sectional study was conducted, including patients who underwent kidney transplantation and exhibited a creeping rise in creatinine within 3 months to one year. Renal biopsies were performed, and the samples were analysed using various techniques.

Results: Among 30 patients included in the study, a high prevalence of acute tubular necrosis20%(n=6), active antibody-mediated rejection20%(n=6),chronic active antibody-mediated rejection20%(n=6), chronic allograft injury10%(n=3), chronic T cell-mediated rejection10%(n=3), acute cellular rejection10%(n=3), membranous nephropathy(n=1), C3 glomerulonephritis(n=1), and cortical necrosis(n=1) was observed. The timing of biopsy post-transplantation and donor HLA mismatch were also evaluated.

Conclusion: These findings emphasize the importance of early detection and proper management of pathological conditions contributing to chronic allograft dysfunction to improve long-term outcomes following kidney transplantation.