Table 1.

Pretransplant biopsy protocol: semiquantitative method of evaluation of slidesa

aOnly biopsies with at least 25 glomeruli are considered for slide evaluation. Kidneys with evidence of acute tubular necrosis are not considered for the double transplant. Biopsies are graded as mild if they have 0 to 3 points in total provided they are less than 3 in any one category. Biopsies are graded as moderate if they have 4 to 6 points in total provided they do not have 3 points in more than one category.
Glomerular global sclerosis
Based on three sections (the first, middle, and last sections, if available); the number of globally sclerosed glomeruli expressed as a percentage.
0 none globally sclerosed
1+ <20% global glomerulosclerosis
2+ 20 to 50% global glomerulosclerosis
3+ >50% global glomerulosclerosis
Tubular atrophy
0 absent
1+ <20% of tubuli affected
2+ 20 to 50% of tubuli affected
3+ >50% of tubuli affected
Interstitial fibrosis
0 absent
1+ <20% of renal tissue replaced by fibrous connective tissue
2+ 20 to 50% of renal tissue replaced by fibrous connective tissue
3+ >50% of renal tissue replaced by fibrous connective tissue
Arterial and arteriolar narrowing
For the vascular lesions, if the changes are focal, the most severe lesion present gives the final grade.
0 absent
1+ increased wall thickness but to a degree that is less than the diameter of the lumen
2+ wall thickness that is equal or slightly greater to the diameter of the lumen
3+ wall thickness that far exceeds the diameter of the lumen with extreme luminal narrowing or occlusion
Final grade
The final grade can range from 0 to a total of 12.
0 to 3 mild OK for single transplant
4 to 6 moderate OK for double transplant
7 to 12 severe should not be transplanted