Acute cell-mediated rejection

Acute cell-mediated rejection

In the era of modern immunosuppressive drugs, the incidence of acute cell-mediated rejection (CMR) is only 10–20%. Acute CMR is largely mediated by direct antigen presentation. As donor APCs in the allograft have a lifespan of only a few weeks, the peak incidence of acute CMR is in the first 3 /uni00A0 months post transplantation. The characteristic biopsy finding of acute CMR is a marked interstitial lymphocytic infiltrate ( Figure 88.8 ). In the kidney , the presence of lymphocytes inside the basement membrane of the renal tubular epithe - lium is referred to as tubulitis and is diagnostic of acute CMR. Initial treatment is by high-dose pulsed intravenous steroids (methylprednisolone 0.5 /uni00A0 g intravenously for 3 days), which is

Figure 88.8 Severe acute renal allograft rejection with a heavy mono

nuclear cell in /f_i ltrate and intimal arteritis.

rejection is treated with lymphocyte-depleting intravenous antithymocyte globulin (ATG).