1 Acute Rejection Classification n Cellmediated rejection Types
- Slides: 8
1 Acute Rejection Classification n Cell-mediated rejection: Types 1, 2, 3 (tubulointerstitial, vascular, transmural) as before n Antibody-mediated rejection (“suspicious” if C 4 d or antibody negative) 1 ATN-like changes with C 4 d and circ. anti HLA antibody 2 Capillary- glomerulitis, polys and monos in PTC with circ. anti HLA antibody &/or C 4 d. 3 Arterial - transmural inflammation/fibrinoid change with circ. anti HLA antibody &/or C 4 d.
V 3 in Cell Mediated Rejection Kim Solez, M. D. and Alexei Sukhanov, M. D
3 V 3 in Cell Mediated Rejection n V 3 common in transplant nephrectomies: n Following withdrawal of immunosuppression. n Often C 4 d not done. n Some cases almost certainly represent severe cell mediated rejection. n Is V 3 found in severe cell mediated rejection on biopsy?
4 Two Cases of V 3 on biopsy in Cases of Cell mediated rejection since 1997 n Both had features of cell mediated rejection: n C 4 d Negative n Tubulitis. n Clinical history not suggestive of antibody.
5 Two Biopsy Cases - Negative for C 4 d n M. T. Tx - 18 March 1997 n Bx # 1. 18 March 1997 (baseline Bx) - No diagnostic changes (G 0 I 0 T 0 V 0 AH 1) n Bx #2. 25 March 1997. History -? Rejection Dx: possible Cs. A tox with endothelial injury superimposed on acute interstitial rejection. n Bx #3. 03 April 1997. History: Recent creat rise, Acute rejection? Dx: Severe "vascular" rejection with minimal tubulointerstitial component. (G 0 I 2 T 1 V 3 AH 0)
6 Two Biopsy Cases - Negative for C 4 d n JV Tx -18 August 1999 n Bx # 1. 18 August 1999(baseline) - Mild degenerative tubular changes withhyaline arteriolar thickening. (G 0 I 0 T 0 V 0 AH 1) n Bx#2 2. 12 November 1999. Base creat. 140, but now unstable + over 200. Dx: Acute vascular rejection with probable viral infection(? BK-virus), (G 0 I 3 T 3 V 1 AH 0) n 3. 03 December 1999 Rebiopsy as creat starting to change. Dx: Severe acute rejection (category 3) Banff score G 0 I 2 T 2 V 3 CG 0 Ci 1 CT 1 CV 1 AH 0
7 Two Biopsy Cases - Negative for C 4 d n JV Tx -18 August 1999 n Bx # 1. 18 August 1999(baseline) - Mild degenerative tubular changes withhyaline arteriolar thickening. (G 0 I 0 T 0 V 0 AH 1) n Bx#2 2. 12 November 1999. Base creat. 140, but now unstable + over 200. Dx: Acute vascular rejection with probable viral infection(? BK-virus), (G 0 I 3 T 3 V 1 AH 0) n 3. 03 December 1999 Rebiopsy as creat starting to change. Dx: Severe acute rejection (category 3) Banff score G 0 I 2 T 2 V 3 CG 0 Ci 1 CT 1 CV 1 AH 0
8 Conclusions n V 3 does occur in cell mediated rejection n Classification has to accept occurrence of V 3 in both cell mediated antibody mediated rejection.
