Info

Fig. 6.6. Acute renal allograft rejection with intraepithelial lymphocytes penetrating the tubular basement membrane producing tubulitis. A. Mild (PAS, x300.) B. Severe (PAS, x600). (Reprinted with permission from: Solid Organ Transplant Rejection, Editor Solez, Publisher Marcel Dekker, Inc., 1991).

Fig. 6.6. Acute renal allograft rejection with intraepithelial lymphocytes penetrating the tubular basement membrane producing tubulitis. A. Mild (PAS, x300.) B. Severe (PAS, x600). (Reprinted with permission from: Solid Organ Transplant Rejection, Editor Solez, Publisher Marcel Dekker, Inc., 1991).

may be successfully reversed with corticosteroids alone, whereas moderate or severe rejections may require the use of anti-T-cell antibody. Acute tubular-interstitial (T-I) rejection may occur repeatedly or relatively late (1+years posttransplant). These latter two circumstances place the patient at high risk for development of chronic allograft rejection. Acute T-I rejection is reversible in >95% of cases.

4. Chronic Rejection

Chronic rejection is a slow and progressive deterioration in renal function, characterized by histologic changes involving the renal tubules, capillaries, and inter-stitium. It is often associated with individuals with recurrent rejection or a late acute rejection episode. The dysfunction is also believed to be complicated by the nephrotoxic effects of the calcineurin inhibitors. The precise mechanisms of this disease are poorly defined and is an area of intense study. Application of conventional antirejection agents, such as corticosteroids or anti-T-cell antibodies do not appear to alter the progressive course. Unfortunately, this is a major cause of kidney allograft loss occurring >2 years posttransplant.

0 0

Post a comment