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Microvascular destruction in renal transplant rejection
G A Bishop1, J A Waugh, D V Landers
1Department of Medicine, Stanford University Medical Center, California 94305.
Transplantation
|September 1, 1989
Summary
Peritubular capillaries in kidney transplants are primary targets of rejection. Damage to these microvascular structures, indicated by reduced HLA-DR expression, can be assessed in biopsies.
Area of Science:
- Nephrology
- Immunology
- Transplantation Biology
Background:
- Kidney graft peritubular and glomerular capillaries express high levels of HLA class I and II.
- These capillaries are susceptible to rejection due to their MHC expression and proximity to lymphocytes.
Purpose of the Study:
- To investigate the fate of peritubular capillaries during renal allograft rejection.
- To determine if peritubular capillaries are a primary target in acute rejection responses.
Main Methods:
- Indirect immunoperoxidase staining technique.
- Monoclonal antibodies against MHC class I, class II, ICAM-1, LFA-3, and E1.5 antigens.
- Assessment of microvascular endothelium markers.
Main Results:
- Decreased expression of HLA-DR on peritubular capillaries during rejection.
- Disappearance of peritubular capillaries in severe rejection, confirmed by loss of endothelium markers.
- Identification of peritubular capillaries as a potential major target in acute rejection.
Conclusions:
- Peritubular capillaries are likely the major targets of acute renal allograft rejection.
- The described techniques enable the assessment of damage to these microvascular structures in biopsies.