Author(s): Kazi JI, Mubarak M
Renal transplantation is the treatment modality of choice for patients with end-stage renal disease (ESRD) throughout the world . The short-term renal transplant outcomes has improved markedly during the last few decades due to improved surgical techniques, better medical care, prevention and treatment of infections, but above all, due to advancements in the field of immunosuppressive treatment . Despite the above accomplishments, renal allograft dysfunction is still common after transplantation and may be caused by acute rejection, chronic rejection, calcineurin inhibitor (CNI) toxicity, infections and other rare causes such as recurrence of original renal disease. Each of the above causes of renal allograft dysfunction requires different therapeutic approach and hence accurate diagnosis is essential for the optimal management of the patients . Clinical diagnosis is unreliable as shown by several studies reporting inability to accurately predict the cause of graft dysfunction in 40 to 70% of cases based on the clinical criteria alone [3-7]. Renal allograft biopsy is the gold standard to accurately establish the cause of renal allograft dysfunction [3,8,9]. It is generally felt that the causes of graft dysfunction vary in live related vs. cadaveric renal transplant settings as well as in different immunosuppressive protocols [10-21]. There are also center to center, and inter-institutional variations in the quality and the incidence of rejection [22-26]. There are very few studies exclusively on the causes of graft dysfunction in a live related renal transplant program [10-15]. The estimated incidence of ESRD in Pakistan is 100 per million population (pmp), with approximately 18,000 new cases each year. More than 90% of the ESRD population in this country is disfranchised from renal replacement therapy (RRT), 10% receive dialysis and 4–5% receive transplants at a rate of <5 pmp . We undertook this preliminary study to evaluate the causes of renal graft dysfunction as detected on renal allograft biopsies in a fairly large cohort of live related renal transplant patients and to compare our findings with those in the literature.