A case of ABO-incompatible renal transplant patient with non-insulin-dependent diabetes mellitus; long-standing observation of serial glomerular change by protocol biopsy

A 41-yr-old patient with non-insulin-dependent diabetes mellitus (NIDDM), b efore and after ABO-incompatible renal transplant, is reviewed using serial protocol biopsy. Although she recovered from delayed hyperacute rejection (DHAR) immediately post-transplantation, her graft function deteriorated gr adually. A mild acute transplant glomerulitis, noted at the 155th day post- transplantation, progressed to pronounced chronic transplant glomerulopathy over 5 yr. In the specimen of the last biopsy, at 5 yr post-transplantatio n, glomeruli demonstrated an exudative hyaline lesion, which was characteri stic of diabetic nephropathy in addition to chronic transplant glomerulopat hy. Therefore, we made a diagnosis of this glomerular lesion as chronic tra nsplant glomerulopathy complicated by diabetic glomerulopathy. Considering the result of this case, the protocol biopsy is a useful procedure to diagn ose an accurate cause of graft dysfunction in individual cases. It is concl uded that the protocol biopsy is apparently useful for the detection of var ious pathological processes occurring in allograft and may contribute to a strategy for improvement of graft survival.