Transcript Lecture 6 Pathology of Renal Transplantation.ppt

Pathology of
Kidney and
the Urinary
tract
Dr. Amar C. Al-Rikabi
Dr. Hala Kasouf Kfouri
Lecture -6
Pathology of Renal
Transplantation
Renal Transplantation is
increasingly being
performed as a treatment
for end-stage renal failure.
Vascular access for
long-term
hemodialysis is
usually provided
through a surgically
created
arteriovenous fistula.
Blood leaves the
patient through the
distal needle to pass
through the distal
needle to pass
through the dialyser
before returning to
the patient through
the proximal
needle. Patients
usually become
adept to inserting
their own needles.
Renal transplantation
Note the two end-stage
native kidneys in normal
position, the atrophic first
donor kidney (lower left),
and the larger second
donor kidney (lower
right).
a)Thrombosis of the surgical vascular
anastomosis leading to graft ischemia.
b)Transplant rejection: Hyperacute, acute,
accelerated acute and chronic rejection.
c)Recurrent of initial disease in the
transplanted kidney like membranoproliferative glomerulonephritis.
 Occurs after very short time of
transplantation.
 Widespread vascular thrombosis.
 Due to pre-formed host antibodies:
blood group incompatibility, previous
blood transfusions or grafts in host.
Subtotal renal infarction
due to hyperacute
(antibody-mediated)
rejection.
 Occurs in a patient who has had
a previous unsuccessful graft and
is therefore already sensitized to
donor antigens.
Severe acute rejection of
donor kidney. Focal
infarcts are present.
A. Acute cellular rejection : T-cells
acting against donor HLA antigens.
B. Acute vascular rejection (humoral
rejection) : here, there is vasculitis
with endothelial cells necrosis and
neutrophil infiltration of blood
vessels.
Acute rejection, Banff Type IA.
This category is defined by the presence of an interstitial infiltrate of lymphocytes which
moderate tubulitis with greater than four mononuclear cells per tubular-cross section.
Acute rejection, Banff Type IB.
In this category interstitial infiltrate is more extensive involving greater than 25% of the
biopsy with numerous foci of severe tubulitis with greater than 10 mononuclear cells per
tubular cross section.
Acute rejection.
The interstitial infiltrate consists of a mixed population of T cells.
Acute rejection, Banff Type IIB.
Severity of Type II is determined by the number of vessels involved as well as the intensity
of the individual lesions.
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Occurs slowly and progressively over a period
of few months.
May be due to inadequate immune
suppression.
Histopathology shows intimal fibrosis of graft
arteries, secondary ischemic changes in
parenchyma.
The renal interstitium is infiltrated by plasma
cells a lymphocytes.
Severe chronic rejection.
(graft arteriopathy). Note the
severe parenchymal atrophy
and the thick-walled arteries.
Chronic/ sclerosing allograft nephropathy.
An example of Grade II-III is characterized by a diffuse increase in interstitial tissue and
marked tubular atrophy as seen on this trichrome stain.
Chronic/ sclerosing allograft nephropathy.
The classical lesion of chronic transplant vasculopathy is a circumferential proliferation of
myointimal cells with an intact internal elastic lamina.