Pathology of chronic humoral rejection

Area of Science:

• Nephrology
• Transplantation Immunology
• Pathology

Background:

• Chronic humoral rejection (CHR) is a significant cause of late kidney graft dysfunction and loss since 2001.
• Pathology primarily affects kidney microvasculature, showing endothelial activation and basement membrane changes.

Purpose of the Study:

• To review diagnostic criteria for CHR.
• To discuss pathologic manifestations and novel molecular markers.
• To cover related experimental animal studies.

Main Methods:

• Kidney biopsy analysis.
• Immunofluorescence for C4d deposition.
• Serological testing for donor-specific antibodies (DSAs).

Main Results:

• CHR diagnosis requires biopsy evidence of C4d deposition in capillaries.
• Definitive diagnosis necessitates detecting donor-specific anti-endothelial antibodies, often against HLA class II antigens.
• Pathologic findings include interstitial fibrosis and tubular atrophy.

Conclusions:

• CHR is a distinct clinical entity requiring specific diagnostic approaches.
• Understanding CHR pathology and diagnostics is crucial for graft survival.
• Ongoing research into molecular markers and animal models may improve CHR management.