Accelerated atherosclerosis with apolipoprotein(a) and oxidized low-density lipoprotein deposition in acute rejection of transplanted kidney: analogous to atherosclerosis.
Atherosclerosis is a chronic inflammatory process affecting mainly elastic and muscular arteries. Although small arteries and arterioles are usually spared, atherosclerosis can occur in these small vasculatures for a very short period. Here we report a case of atherosclerosis-like lesions that occurred in a transplanted kidney showing acute accelerated rejection in a 43-year-old man. Histologically, biopsy specimens at 14 and 28 days and nephrectomy material at 52 days post-transplantation showed atherosclerosis-like lesions in various-sized arteries. The lesions were characterized by the intimal infiltration of inflammatory cells, including foamy macrophages and a variable number of T-lymphocytes, with smooth muscle cell proliferation. Immunohistochemistry disclosed that the foam cells expressing CD68 contained oxidized LDL. In addition, apolipoprotein(a) (Lp(a)), another major atherogenic lipoprotein, was found in the intimal smooth muscle layer, suggesting that Lp(a) induced smooth muscle cell proliferation in the rejected kidney as a mechanism of atherosclerosis. This case shows that immunoinflammatory reactions during a relatively short period can mimic the chronic atherosclerotic process even in small arteries and arterioles. Furthermore, the deposition of atherogenic lipoproteins, Lp(a) and oxidized LDL in lesions of rejected tissue present an analogy between vascular rejection in transplanted kidney and atherosclerosis.
Shimoyamada
Hiroaki
H
Department of Pathology, Tsukuba Hospital, Japan.
Fan
Jianglin
J
Watanabe
Teruo
T
Nagata
Michio
M
D000328:Adult; D001053:Apolipoproteins / Q000032:analysis*; D053241:Apoprotein(a); D001161:Arteriosclerosis / Q000473:pathology*; D006084:Graft Rejection / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D007668:Kidney / Q000378:metabolism* / Q000473:pathology*; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation; D017270:Lipoprotein(a) / Q000032:analysis*; D008077:Lipoproteins, LDL / Q000032:analysis*; D008297:Male; D010084:Oxidation-Reduction
D001053:Apolipoproteins; D017270:Lipoprotein(a); D008077:Lipoproteins, LDL; D053241:Apoprotein(a)