Renal allograft biopsy: a satisfactory adjunct for predicting renal function after graft rejection.

Forty-four biopsies of transplanted kidneys undergoing rejection were examined by light microscopy without knowledge of the eventual clinical outcome. All patients received extensive antirejection medication. A scoring system based on nine histopathologic criteria was formulated to predict whether the serum creatinine would be less than 1.8 mg/dl (good prognosis), 1.8 to 2.5 mg/dl (fair), or greater than 2.5 mg/dl (poor), two months after biopsy. Predictions were accurate in 37 of the 44 cases. In some cases with relatively minimal vascular changes the prognosis was poor, whereas heavy cellular infiltreate without vessel damage did not necessarily preclude functional recovery. It was concluded that specific histopathologic pictures should enable the physician to decide whether to institute extensive antirejection therapy or adopt alternative measures.