Background: No studies using a valid, standardized method to measure post-donation satisfaction levels among living kidney donors (LKDs) have been published. Methods: Donor satisfaction levels were measured using the Japanese version of the Client Satisfaction Questionnaire-8 (CSQ-8), a validated, self-report questionnaire. To identify factors related to post-donation satisfaction levels, we compared donors’ sociodemographic and psychological characteristics and health-related quality of life (HRQoL), using the Short Form-36 Health Survey (SF-36), as well as recipients’ clinical characteristics and SF-36 scores between donors with and without low satisfaction. In addition, donors’ perceptions of the donation results and transplant procedure were assessed using measures that we developed. Results: The mean (standard deviation [SD]) CSQ-8 score for the 195 participants was 26.9 (3.4). Twenty-nine (14.9%) respondents with total scores < 1 SD below the mean CSQ-8 score were placed into the low satisfaction group. Multiple logistic regression analysis demonstrated that lower perceptions of receiving adequate information prior to transplantation (odds ratio [OR] = 0.17; 95% confidence interval [CI] = 0.079–0.379; p < 0.001), lower optimism according to the Life Orientation Test (OR = 1.24; 95% CI = 1.045–1.470; p = 0.014), and increased serum creatinine levels in the paired recipient (OR = 0.05; 95% CI = 0.250–1.011; p = 0.054) independently increased the odds of having less satisfaction with donation. Conclusions: Our findings suggest that careful pre-donation education and more detailed informed consent may be needed, especially in LKDs with low constitutional optimism.

Aim: We carried out a clinicopathological analysis of cases presenting with interstitial fibrosis and tubular atrophy (IF/TA) after renal transplantation in an attempt to clarify the mechanisms underlying the development and prognostic significance of IF/TA.Methods: IF/TA was diagnosed in 35 renal allograft biopsy specimens (BS) obtained from 35 renal transplant recipients under follow up at the Department of Transplant Surgery, Kidney Center, Toda Chuo General Hospital, between January 2014 and March 2015.Results: IF/TA was diagnosed at a median of 39.9 months after the transplantation. Among the 35 patients with IF/TA, 19 (54%) had a history of acute rejection. Among the 35 BS showing evidence of IF/TA, the IF/TA was grade I in 25, grade II in 9, and grade III in 1. Arteriosclerosis of the middle‐sized arteries was observed in 30 BS (86%). We then classified the 35 BS showing evidence of IF/TA according to their overall histopathological features, as follows; IF/TA alone (6 BS; 17%), IF/TA + medullary ray injury (12 BS; 34%), and IF/TA + rejection (12 BS; 34%). Loss of the renal allograft occurred during the observation period in one of the patients (3%). Of the remaining patients with functioning grafts, deterioration of the renal allograft function after the biopsies occurred in 15 patients (43%).Conclusions: The results of our study suggests that rejection contributes to IF/TA in 30–40% of cases, medullary ray injury in 30–40% of cases, and nonspecific injury in 20% of cases. IF/TA contributes significantly to deterioration of renal allograft function.

Background: The 16th Banff Meeting for Allograft Pathology was held in Banff, Canada from September 19 to 23, 2022. The results were published in the American Journal of Transplantation in March this year as “The Banff 2022 Kidney Meeting Report: Reappraisal of Microvascular Inflammation and the Role of Biopsy-Based Transcript Diagnostics.” Summary: The changes in the Banff 2022 classification (Banff 2022) have four distinct features. The first was the modification of antibody-mediated rejection (AMR). The key points are microvascular inflammation/injury (MVI); the presence or absence of C4d deposition in the peritubular capillaries; and the presence or absence of donor-specific antibodies (DSAs). Even if the MVI is above the threshold, if C4d and DSA are negative, it is not classified as AMR but as “MVI, DSA-negative, and C4d-negative.” Furthermore, if MVI is below the threshold, C4d is negative but DSA is positive, the patient is classified under “probable AMR.” Second, patients with acute tubular injury (ATI) without other obvious causes such as ischemia are excluded from AMR. Third, the Banff cv score for “arterial intimal fibrosis of new onset” (AIFNO) is excluded from AMR when used alone. Fourth, non-human leukocyte antigen (HLA) antibodies, except for anti-blood group antibodies in ABO-incompatible kidney transplants, were excluded from DSA and included in the diagnostic criteria for AMR. Key Messages: The changes in Banff 2022 are as follows: implementation of new terminology, such as MVI, DSA-negative, and C4d-negative and probable AMR, ATI, and AIFNO are excluded from AMR, and non-HLA antibodies are excluded from DSA.

Introduction: Herein, we discuss clinicopathological analyses of cases of chronic renal allograft arteriopathy (CRA) after renal transplantation and clarify the mechanisms underlying the development and prognostic significance of CRA. Methods: CRA was diagnosed in 34 renal allograft biopsy specimens (BSs) obtained from 27 renal transplant patients who were followed up at the Department of Urology and Transplant Surgery, Toda Chuo General Hospital, between January 2010 and December 2020. Results: CRA was diagnosed at a median of 33.4 months post-transplantation. Of the 27 patients, 16 had a history of rejection. Among the 34 BSs showing evidence of CRA, CRA was mild (cv1 in Banff’s classification) in 22, moderate (cv2) in 7, and severe (cv3) in 5 patients. We then classified the 34 BSs showing evidence of CRA based on their overall histopathological features as follows: cv alone seen in 11 (32%) BSs, cv + antibody-mediated rejection (AMR) in 12 (35%), and cv + T-cell-mediated rejection (TCMR) in 8 (24%). Loss of the renal allograft occurred during the observation period in 3 patients (11%). Of the remaining patients with functioning grafts, deterioration of renal allograft function after biopsies occurred in 7 cases (26%). Conclusions: Our study results suggest that AMR contributes to CRA in 30–40% of cases, TCMR in 20–30% of cases, isolated v lesions in 15% of cases, and cv lesions alone in 30%. The intimal arteritis was a prognostic factor in CRA.