J Korean Soc Transplant.  2017 Dec;31(4):170-176. 10.4285/jkstn.2017.31.4.170.

Investigation and Standardization on Current Practice of Renal Transplant Pathology in Korea

• Cho U
• Suh KS
• Kie JH
• Choi YJ
• Renal Pathology Study Group of Korean Society of Pathologists

• KMID: 2401567
• DOI: http://doi.org/10.4285/jkstn.2017.31.4.170

Abstract

We need to establish an informative guideline to increase inter-institutional and inter-observer reproducibility of renal transplant diagnosis, and to improve the diagnostic ability of pathologists in Korea. A first nation-wide survey for renal transplant pathology was conducted by Renal Pathology Study Group of the Korean Society of Pathologists in 2016, to provide the continued excellence in the transplantation pathology laboratory, and to improve the diagnostic ability for the best treatment of transplant patients. This survey revealed the significant variations in scale, work load and biopsy indications for the renal transplant pathology in various institutions in Korea. The Banff classification were used by all institutions for the diagnosis of renal transplant pathology, but different formats were used: most institutions (70%) used the "2013 Banff classification" while the others were using "2007 Banff classification" (20%) or even older formats. In daily diagnostic practice of the renal allografts, difficulties that pathologists encounter were quite diverse due to different environments they work in. Most respondents agreed that standardized diagnostic practice guidelines, regular education on renal transplant pathology and convenient ways of consultation are further needed. We are currently working toward the enhancement of the expertise of renal pathologists and to increase inter-institutional and inter-observer reproducibility by 1) development of a set of virtual slides of renal allograft biopsies for the training, 2) validation and gathering expert's consensus on the core variables of rejection diagnosis by using virtual slides, and 3) continued education by the developed virtual slide atlas.

Keyword

Kidney; Transplantation; Pathology; Diagnosis; Standardization

MeSH Terms

Allografts
Biopsy
Classification
Consensus
Diagnosis
Education
Humans
Kidney
Korea*
Pathology*
Surveys and Questionnaires
Transplantation

Figure

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  Fig. 1 Number of renal graft biopsy diagnosed in each institution. (A) What is the number of renal graft biopsy diagnosed in your insitution during the year 2015? (B) Percentage of institutions that handle <25, 25~100, and >100 renal allograft cases annually.

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  Fig. 2 Experience of the renal pathologists. (A) What is your position in your institution? (B) How many years of experience do you have in the renal transplant pathology?

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  Fig. 3 What kind of renal graft biopsy is performed in your instititution?

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  Fig. 4 What is the average turn-around-time from receivement of the biopsy to diagnosis reporting in your instititution?

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  Fig. 5 What classifciation do you use for the reporting of renal graft rejection?

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  Fig. 6 What kind of ancillary test do you perform for the diagnosis of antibody mediated rejection?

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  Fig. 7 What are the causes of difficulty in the daily practice of renal allograft pathology?

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  Fig. 8 A capture screen image of a virtual slide of a renal allograft biopsy on web. Users can access to the virtual slides with accompanied clinical information and use it for reference image during the diagnostic practice.

Reference

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