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Related Experiment Videos

Acute vascular rejection: a clinical and morphological study

M C Castro1, D S David, L B Saldanha

  • 1Renal Transplantation Unit, São Paulo University, Brazil.

Transplant International : Official Journal of the European Society for Organ Transplantation
|July 17, 1998
PubMed
Summary

This study identifies a specific acute vascular rejection (AVR) pattern causing early kidney failure. Oliguria and arterial lesions in arcuate and interlobular arteries predict poor outcomes in renal transplant patients.

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Area of Science:

  • Nephrology
  • Transplantation Immunology
  • Vascular Pathology

Background:

  • Acute vascular rejection (AVR) can lead to early renal graft failure.
  • A specific histological pattern of AVR involves fibrous thickening of the arterial intimal layer.
  • Understanding the progression and prognostic factors of this AVR subtype is crucial.

Purpose of the Study:

  • To analyze a specific type of acute vascular rejection (AVR) characterized by arterial intimal fibrous thickening.
  • To identify clinical and histological predictors of graft outcome in patients with this AVR pattern.
  • To determine the incidence and prognostic value of this AVR subtype in renal transplantation.

Main Methods:

  • Retrospective analysis of 339 renal transplants over 4 years.

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  • Identification of 21 patients with AVR defined by arterial intimal fibrous thickening.
  • Comparison of graft survival, clinical presentation (oliguria), and histological findings (arterial involvement) between patients who retained or lost their grafts.

    • Main Results:

    • The specific AVR pattern was identified in 21 patients (approx. 6.2%), leading to graft loss in 38% of cases.
    • Oliguria was significantly more frequent in patients who lost their grafts (75% vs. 15.3%, P=0.01).
    • Lesions progressing from arcuate to interlobular arteries significantly increased renal loss (72.2% vs. 22.5%, P=0.006).

    Conclusions:

    • This specific AVR subtype, diagnosed around the 43rd postoperative day, accounts for approximately 2.3% of renal graft losses.
    • Oliguria is the primary clinical predictor of poor graft reversibility.
    • The extent of arterial involvement, particularly affecting both arcuate and interlobular arteries, indicates a poor prognosis, while immunofluorescence lacks prognostic value.