Peritubular capillary damage in acute humoral rejection:: An ultrastructural study on human renal allografts

被引:45
作者
Lipták, P
Kemény, É
Morvay, Z
Szederkényi, E
Szenohradszky, P
Marofka, F
Toldi, J
Exner, M
Iványi, B
机构
[1] Univ Szeged, Dept Pathol, H-6720 Szeged, Hungary
[2] Univ Szeged, Dept Radiol, H-6720 Szeged, Hungary
[3] Univ Szeged, Dept Transplant Surg, H-6720 Szeged, Hungary
[4] NBTS, Reg Transfus Ctr, Szeged, Hungary
[5] Univ Vienna, Clin Inst Pathol, Vienna, Austria
[6] Univ Vienna, Dept Lab Med, Vienna, Austria
关键词
apoptosis; humoral rejection; kidney; peritubular capillary; ultrastructure;
D O I
10.1111/j.1600-6143.2005.01102.x
中图分类号
R61 [外科手术学];
学科分类号
摘要
The ultrastructural features of peritubular capillary (PC) damage was studied in 12 kidney allografts with acute humoral rejection (AHR). AHR manifested in diffuse linear PC staining for C4d, and histology consistent with Banff grade III in 7 recipients and Banff grade II in 5. Allografts with acute tubular necrosis served as controls. First biopsies (post-transplantation day 16.2 +/- 2.2): The intra-capillary exudate comprised monocytes (59%), polymorphonuclears (14%), lymphocytes (12%) and not otherwise specified mononuclears (15%). Three patterns of focal PC endothelial injury were observed: lysis, an increased rate of apoptosis and fragmentation. No correlation was found between the respective damage types and the inflammatory cell types or the Banff grades. Controls revealed endothelial swelling, detachment from basement membrane and fragmentation. Follow-up biopsies: Monocytes transformed into macrophages intra-luminally. The reparative changes comprised endothelial cytoplasmic protrusions, binucleated endothelial cells and capillary sprouts. Early transplant capillaropathy and transplant glomerulopathy were noted in 2 recipients. Literature data indicate that lysis is mediated by anti-HLA alloantibodies; apoptosis, demonstrated first in the present study, may be induced by non-HLA-type anti-endothelial antibodies. Fragmentation is caused by ischemia. Ongoing endothelial injury leads to transplant capillaropathy and transplant glomerulopathy, the characteristic lesions of chronic rejection.
引用
收藏
页码:2870 / 2876
页数:7
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