Unusual vascular findings in transplanted kidneys

Of 189 unsuccessful renal transplant cases, eight were selected for retrospective analysis because they had been classified histologically as "chronic rejection with marked vascular changes" even though they had been removed less than 60 days after transplantation. Review of these cases revealed that only one of the eight transplants had postoperative function and that this transplant had only marginal functions. All eight kidneys had intimal damage that was unlike the usual lesions of rejection. Five kidneys showed evidence of thrombosis with recanalization, and five had what appeared to be a double layer of the intima. The findings in eight cases suggest that severe intimal damage occurred within 60 days of implantation and may not represent the usual rejection processes; it may reflect, in part, damage to the intima prior to or during implantation.