Conferencia de clausura: Vascular pathology in the renal transplant

Dr. Eduardo Vázquez Martul^[1]
(1) Servicio A. Patológica. Hospital Universitario Juan Canalejo. Coruña ESPAÑA

Resumen

Introduction    

Donor Pathology    

fiogf49gjkf0dFigure nº 1.- Vascular donor pathology. Arterial sclerosis and hyalinosis arteririolar. PAS.">
Fig 1 -

Immunological mechanisms of Renal Vascular Pathology    

fiogf49gjkf0dFigure nº 2.- Severe Endothelitis (grade IIB- Banff classification).">
Fig.2 -

fiogf49gjkf0dFigure nº 3.- Diffuse and intense C4d positivity.">
Fig.3 -

fiogf49gjkf0dFigure nº 4.- Arteriolar hyalinosis and glomerulosclerosis related with chronic toxicity.">
Fig.4 -

fiogf49gjkf0dFigure nº 5.- Atheroembolic disease as a cause of allograft lost.">
Fig.5 -

fiogf49gjkf0dFigure nº 6.- Chronic allograft vasculopathy. Concentric and symmetric proliferation of subintima with luminal narrowing.">
Fig.6 -

fiogf49gjkf0dFigure nº 7.- Multilamellar basal laminae in peri-tubular capillaries.">
Fig.7 -

Conclusions    

• Vascular Pathology in the donor kidneys particularly those from donors > 65 years old or succumbing to CVA etc., exerts a significant negative impact in the allograft prognosis. It augments the initial ischemic effect, predisposes to acute rejection and accelerates the development of chronic allograft vasculopathy in the graft.

• Similarly, in donors experiencing a prolonged asystole, the marked  ischemic damage of the vessels can complicate the differential diagnosis from later acquired lesions such as vascular pathology secondary to humoral immunity or myocyte necrosis in the vascular walls due to toxicity.

• The vascular damage resulting from acute vascular rejection particularly of Banff types IIB and III represent an independent poor prognostic factor for the graph.  The presence of fibrinoid necrosis of the vascular wall and/or thrombotic microangiopathy is highly suggestive of humoral rejection.
  
• The histological presentation of chronic allograft vasculopathy in its first phase of evolution characterized by endotheliitis, and concentric subintimal fibrosis, is diagnostic of chronic vascular rejection.  On the other hand, in more advanced cases these specific lesions may overlap with arteriosclerotic lesions making the differential diagnosis more problematic.
  
• The arteriolar hyalinosis is a lesion associated with calcineurin inhibitor treatment.  Although there is a potential temporal relationship between the vasculopathy and the drug administration, there is no absolute correlation between this lesion and deterioration of graft function.
  
• The immunosuppressive treatment induces important lipid metabolic changes predisposing to increased arteriosclerotic changes in the allograft biopsies.
  
• It is important to consider in the graft vascular pathology the potential recurrence of vasculitis.
  
• Recently, pathogenetic consideration has been attributed to additional forms of arterosclerosis such as the atheroembolic disease, which can lead to graft loss during the early post-transplant periods as well as during the later ones.

Bibliografía    

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Comentarios

- Liudmila Montano Rodríquez (03/07/2007 17:06:22)

Dr, considero muy buena su conferencia, me sirvió de mucho el análisis realizado por usted. Gracias