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Electron microscopic peritubular capillary lesions: a new criterion for chronic rejection
T Oikawa1, K Morozumi, K Koyama
1Third Department of Internal Medicine, Nagoya City University Medical School, Nagoya, Japan. oikawa@med.nagoya-cu.ac.jp
Clinical Transplantation
|April 6, 2000
Summary
Multi-layered basement membrane lesions (MLPTC) are a valuable indicator of chronic rejection in kidney transplant patients treated with cyclosporin A. This finding helps identify chronic rejection, even when typical signs are absent.
Area of Science:
- Nephrology
- Transplantation Immunology
- Pathology
Background:
- Chronic rejection is a major cause of renal allograft loss.
- Cyclosporin A (CsA) has altered the presentation of chronic rejection.
- Traditional markers like glomerular and arterial lesions are less common with CsA therapy.
Purpose of the Study:
- To evaluate the utility of peritubular capillary lesions as a criterion for chronic rejection.
- To investigate the significance of multi-layered basement membrane lesions (MLPTC) in the CsA era.
Main Methods:
- Analysis of 129 renal graft biopsies from patients with graft dysfunction (>2 months post-op).
- Electron microscopy examination focusing on peritubular capillary lesions, particularly MLPTC.
- Comparison with 82 control biopsies from non-transplantation patients.
Main Results:
- MLPTC were identified in 42.6% of allograft biopsies, compared to 6% in controls.
- Incomplete MLPTC were associated with acute rejection and occurred frequently within the first year.
- Typical MLPTC incidence was 5.7-12.8% post-operatively.
- MLPTC prevalence did not correlate significantly with the time interval from operation to biopsy.
Conclusions:
- MLPTC serves as a specific diagnostic criterion for chronic renal allograft rejection.
- The development of chronic rejection is linked to recurrent, often subclinical, acute tubulo-interstitial rejection.
- MLPTC are a key indicator in diagnosing chronic rejection in the CsA treatment era.