Untitled - Roche Trasplantes

PROTOCOL BIOPSIES AND THE DIAGNOSIS OF HUMORAL REJECTION
Figure 4. Chronic transplant glomerulopathy with thickening and duplication
of peripheral basement membranes. In capillary loops still inflammatory
cells can be appreciated as a sign of ongoing immunological damage
to the endothelial cells.
Yet (2006), specific pathological features of chronic humoral rejection are not officially
part of the current up-dated Banff classification system. However, at the two recent
Banff meetings in 2003 and 2005 an open-forum consensus-discussion was proceeded
to confirm the entity of chronic humoral rejection and to define diagnostic criteria.
In was agreed that this entity exists and that it should be part of the classification in
the future. Based on several publications, beside non-specific features of chronic allograft
damage like tubular atrophy and interstitial fibrosis, the following pathological features
appear to be specific diagnostic hallmarks of chronic antibody-mediated allograft
damage:
• Duplication of glomerular basement membrane, i.e., chronic allograft glomerulopathy
(Figure 4, Figure 5).
• Intimal myofibroblastic and foam cell proliferation in allograft arteries (Figure 6) with infiltration
of mononuclear cells and few T-lymphocytes (Figure 7), i.e., chronic allograft
vasculopathy.
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