Diagnosis of renal transplant rejection by fine needle aspiration cytology

Abstract

True cut needle biopsy of the transplant has been the standard method for detection of rejection. Yet it carries risks of bleeding and infection. However fine needle aspiration biopsy can be done without risk to the graft or recipient , Objective: To establish the place of fine needle aspiration biopsy in the diagnosis of transplant rejection and to replace true cut biopsy with fine needle aspiration biopsy whenever possible. Design and Settings: Aspiration biopsy was performed on 5 patients admitted to professorial unit of Medicine, Colombo with clinical signs of rejection. Sample was cytocentrifuged and slides were stained with Giemsa and examined under the microscope. In three, a true cut biopsy was performed in addition to fine needle aspiration biopsy. Results: In the first patient the aspiration was performed on the 8th post operative day. Aspirate contained blood with exudate. True cut biopsy was not performed as renal functions improved. In 2 patients the aspirate showed cytological features of cellular rejection. True cut biopsy confirmed acute cellular rejection. In the 4th patient there were no features of rejection both in the aspirate and in the biopsy. In the last patient who was obese aspiration did not reveal any parenchymal cells. Conclusions: This preliminary study shows that transplant aspiration cytology can be used to diagnose early rejection. Aspiration cytology is a minimally invasive method for repeated, even daily monitoring of the renal graft. Results of aspiration biopsy are obtainable within one hour.