[Pathologic features of acute allograft rejection in ABO-incompatible renal transplantation].
BACKGROUND
In order to examine the difference in histological findings during acute rejection between ABO-incompatible renal transplantation and compatible, we studied biopsy specimens from renal allografts histopathologically.


METHODS
Twenty one ABO-incompatible cases (ICBG) and fifteen compatible cases (CBG) who were transplanted at Tokyo Women's Medical College and considered to have acute rejection clinically were selected. Lightmicroscopic findings classified Banff schema, deposition of globulins and complements, expression of HLA class II antigen (DR) and adhesion molecules (ICAM-1, VCAM-1), subset of infiltrating cells, blood type antigen and specific antigen for endothelium (Thrombomoduline: TM, Factor VIII) were compared between CBG and ICBG on biopsy specimens.


RESULTS
Tubulitis was observed in 71.4% of ICBG and all cases of CBG. Severe interstitial infiltration of CD8 positive cells and polymorphonuclear leucocyte (PMN) glomerular infiltration was showed in 52%, 85.7% of ICBG and 100%, 0% of CBG. The incidence of fibrinogen deposits was 47.6% in ICBG and 26.7% in CBG. Tubular expression of DR, ICAM-1 and VCAM-1 were positive in 25%, 40%, 45% of ICBG and 91.7%, 100%, 100% of CBG. Monoclonal antibody for TM was demonstrated more strongly positive in CBG (73.3%) than in ICBG (28.6%). These findings had significant differences in ICBG from CBG.


CONCLUSIONS
Acute rejection of ABO-compatible renal transplantation was characterized by tubulitis accompanied by high expression of DR, ICAM-1 and VCAM-1, which subsequently injure tubulo-interstitium. On the other hand, ABO-incompatible acute rejection showed endothelial injury characterized by fibrinogen deposition and severe PMN infiltration in glomeruli (glomerulitis).
Onitsuka
S
S
Department of Urology, Tokyo Women's Medical College.
D000017:ABO Blood-Group System; D000208:Acute Disease; D000328:Adult; D001787:Blood Group Incompatibility / Q000276:immunology*; D015815:Cell Adhesion Molecules / Q000032:analysis; D005169:Factor VIII / Q000032:analysis; D005260:Female; D006084:Graft Rejection / Q000276:immunology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000473:pathology*; D016030:Kidney Transplantation / Q000276:immunology* / Q000473:pathology; D008297:Male; D018180:Thrombomodulin / Q000032:analysis
D000017:ABO Blood-Group System; D015815:Cell Adhesion Molecules; D007166:Immunosuppressive Agents; D018180:Thrombomodulin; D005169:Factor VIII