Background:Early diagnosis of transplant kidney biopsy histology is of great significance, and there are few single-center retrospective studies of clinical diagnosis and treatment. OBJECTIVE: To perform routine puncture pathology biopsy on transplanted kidneys with renal insufficiency, to observe the therapeutic effect by adopting the corresponding clinical treatment according to the pathological diagnosis, and to clarify the safety of transplanted kidney puncture pathology biopsy as well as its significance and importance in clinical diagnosis and treatment. Methods: 202 renal transplant patients were selected from the organ transplantation center of the 309th Hospital of the People’s Liberation Army, of which 80 had delayed recovery of transplanted kidney function after transplantation and 122 had unexplained creatinine elevation. The biopsies were stained and histologically observed accordingly, and the corresponding clinical treatment was performed. Results and conclusions: Among the punctured tissues, except for 3 cases (1.5%), which were difficult to diagnose due to the small amount of tissue, 12 cases (5.9%) were pathologically diagnosed as normal transplanted kidney, 28 cases (13.9%) were combined with ischemia-reperfusion injury (or) acute tubular necrosis, 22 cases (10.9%) were mildly acute toxic injury of calcium phosphatase inhibitor-like immunosuppressant, and 12 cases (10.9%) were mildly chronic toxic injury of calcium phosphatase inhibitor-like immunosuppressant. (5.9%), 1 hyperacute rejection (0.5%), 29 suspected acute rejection (14.4%), 34 acute T-cell rejection (16.8%), 19 acute antibody-mediated rejection (9.4%), 16 chronic T-cell-mediated rejection (7.9%), chronic T-cell-mediated rejection with acute T-cell-mediated rejection in 12 cases (5.9%), chronic antibody-mediated rejection in 3 cases (1.5%), hypertensive factors in 4 cases (2.0%), interstitial fibrosis and tubular atrophy, lesions not due to specific causative factors in 2 cases (1.0%), ischemic necrosis in 2 cases (1.0%), recurrence of post-transplant nephropathy in 3 cases (1.5%), C4d immunohistochemical staining There were 23 cases (11.4%) with positive immunohistochemical staining, and no adverse reactions of patients or transplanted kidneys were found. Han Yong, All-Army Transplantation Institute, 309th Hospital, PLA