The best way to treat irreversible chronic failure of the kidneys and the heart is organ transplantation. While specialized centers manage patients at time of transplantation and during the initial post transplantation period, peripheral referral centers and local physicians are frequently involved in long-term patient care and follow-up. Transplant biopsies are considered to be the gold standard to properly evaluate the condition of the graft and to diagnose any cause of “unexplained” allograft dysfunction. Thus, heart and kidney transplant biopsies may be seen in many pathology practices, and (on-call) pathologists are not infrequently challenged to render “rush” diagnoses that may form the basis for intense and potentially harmful treatment regimens.

The aim of this short course is to provide a general didactic, partially case-based, presentation of common and problematic disorders seen in heart and kidney allografts. We will focus on morphologic as well as pertinent pathophysiologic aspects and provide the audience with general concepts for the handling and interpretation of allograft biopsies. Strengths and limitations of currently used classification schemes of acute and chronic rejection will be discussed. The course will not only cover morphologic changes induced by cellular or antibody mediated rejection, but also other challenging disease entities such as ischemia reperfusion injury, Quilty lesions, post transplant lymphoproliferative disorders, calcineurin inhibitor induced toxic changes, and polyomavirus-allograft nephropathy. The presentation will be divided into three major blocks: common aspects of heart and kidney transplantation will be covered in a brief introductory session followed by an in-depth discussion of heart (approximately 60 minutes) and renal allograft pathology (approximately 100 minutes). There will be ample time for discussion. Our goal is to provide a systematic, step-wise approach to the diagnostic work-up of kidney and heart transplant biopsies including the use of ancillary techniques, e.g. stains to detect C4d or MHC-class II. We will stress the importance of close clinico-pathologic correlation in order to make specific diagnoses and to improve patient management.

This course aims to improve the general understanding of “allograft” pathology and to help pathologists to render specific diagnoses using an algorithmic diagnostic approach. Our course is suited for practicing general pathologists as well as advanced pathology residents and fellows with interest in organ transplantation. A CD-ROM of representative cases/images will be available for mailing to registrants prior to the meeting. These cases will be discussed in more detail during the course. An extensive syllabus will be distributed at the time of the course, and a CD-ROM of additional materials containing key images from the presentation will be mailed after the meeting.