50-year-old female underwent nephrectomy because of transplant failure 5 months following renal transplantation. The latter had been initially performed due to end-stage chronic glomerulonephritis.
- Extensive fresh infarct.
- Medium-sized and large caliber arteries exhibit a profound thickening of the wall consisting of a concentric, onion-skin intimal fibroplasia leading to complete arterial occlusion.
- Outside of infarct, severe interstitial fibrosis with loss of renal parenchyma; tubuli are largely missing, glomeruli are destroyed.
Chronic transplant arteriopathy is the most specific morphologic lesion of chronic rejection.
Mixed, humoral and cellular immune mechanisms and other factors (e.g. calcineurin inhibitor toxicity) contribute to chronic rejection.
Clinical findings: Transplant failure leads to symptoms of chronic renal insufficiency (e.g. generalized edemas).