Untitled - Roche Trasplantes

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PROTOCOL BIOPSIES AND THE DIAGNOSIS OF HUMORAL REJECTION Figure 6. Intimal accumulation of foam cells is the hallmark of chronic transplant vasculopathy and leads to lumen narrowing and decreased perfusion with chronic ischemia of the allograft. Additionally, myofibroblasts invade and proliferate in the subendothelial and intimal space. Figure 7. As a hint to a concomitant T-cell-mediated immunological pathogenesis of transplant vasculopathy sometimes scattered T-lymphocytes (positive for CD3 in the immunohistochemical reaction) can be found in the extended subendothelial space (arrows) adjacent to the foam cells. 59
BIOPSIA DE PROTOCOLO EN EL TRASPLANTE RENAL Figure 8. Only by electron microscopy chronic transplant capillaropathy can be detected. At least five, better seven lamellas should be found in the basement membrane of peritubular capillaries to make the diagnosis. mediated allograft injury, respectively. More than 80% of patients with chronic signs of humoral allograft damage and specific C4d detection in peritubular capillaries have simultaneously circulating donor-specific antibodies in their sera. In this context, a study from the Vienna group was able to show in sequential biopsies that C4d detection precedes the later onset of chronic transplant glomerulopathy and has herewith a predictive value. Comparable data are available for the chronic-humoral pathogenesis of transplant capillaropathy. These findings suggest that C4d deposition indicates episodes of active humoral responses to the allograft and represent an early stage of chronic irreversible allograft damage. Against this background timely detection of C4d might allow for specific therapeutic intervention at least attenuating chronic humoral rejection. However, a contribution of T-cell-mediated injury to chronic rejection and the onset of glomerulopathy, vasculopathy, or capillaropathy, beside chronic predominantly tubulointerstitial allograft damage, might also be likely. Further studies are urgently needed to define more precisely different entities of chronic allograft damage, which are currently all lumped together in the non-specific term of chronic allograft nephropathy. 60
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DRUG Edificio Vértice Antonio Lóp
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