Renal Transplantation

Question 1

What are the two main targets on the transplanted kidney?

Answer 1

ABO blood groups and HLA antigens

Question 2

What is the most commonly encountered target of kidney rejection?

Answer 2

Acute and chronic rejection caused by donor HLA antigens

Question 3

If recipient blood with antibodies to major alloantigens enters graft vessels, what occurs?

Answer 3

Abs bind endothelial cells resulting in hyperacute humoral rejection

Question 4

Anti-C4d Ab fluorescence is shown below on a renal allograft. What type of rejection is occuring? If extensive fibrinoid necrosis occurred, what would the Dx be?

Answer 4

Acute humoral allograft rejection; Acute humoral necrotizing acute vasculitis

Question 5

Acute Cellular Rejection of a renal transplant is shown. How frequent is this condition? What type of infiltrates are seen?

Answer 5

This is the most common form of acute rejection; T lymphocytes and macrophages

Question 6

What are the two processes that occur in chronic humoral rejection?

Answer 6

Chronic transplant arteriopathy and chronic transplant glomerulopathy

Question 7

Chronic humoral allograft rejection is shown. What are the typical characteristics of this condition?

Answer 7

Intimal thickening by stromal cell proliferation and matrix deposition but without dense fibrosis/elastic lamination seen in nonspecific arteriosclerosis. INFLAMMATION IS ABSENT

Question 8

Characteristic arteriolopathy including smooth muscle cell degeneration and necrosis is observed. What is the Dx?

Answer 8

Cyclosporine nephrotoxicity