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. Author manuscript; available in PMC: 2012 Jul 1.
Published in final edited form as: Am J Transplant. 2011 Jun 10;11(7):1464–1477. doi: 10.1111/j.1600-6143.2011.03572.x

Table 1.

Clinical and Pathologic Features

Recipient 1 2 3 4 5 6 7 8 9 10
Bx 1 1 1 1 1 1 1 2 1 1 1 2
Day Post-transplant 24 10 10 12 13 11 12 13 10 10 13 16
Serum Cr At Bx 1.4 4.8 4.2 1.8 4.5 2.5 2.1 4.1 2.3 1.6 2.0 9.0
Peak 1.4 11.9 8.3 3.7 7.2 5.8 6.7 4.8 4.6 15.4
Last 1.3 2.0 2 1.8 2.0 1.6 0.7 3 1.1 1.7
Time 7 y 6.5 2 m 3 y 4 y 1 y 1 y 6 mo 6 mo 6 mo
Symptoms None Fever, fluid retention Fever, fluid retention Minor fever, fluid retention Minor fever, fluid retention Minor fluid retention Minor fluid retention No symptoms Minor fluid retention Minor fever, minor fluid retention
Treatment No additional treatment Steroid pulse ATG, PE, Rituxan, IVIG Steroid pulse x3 ATG, PE, Rituxan No additional treatment ATG, PE x3 No additional treatment (ATG later) No additional treatment ATG; stopped tacrolimus
Banff Acute Rejection Category None None AHR None AHR None ACR2 None None None None ACR2
Light Microscopy PTC Congestion - +++ +++ + +++ ++ +++ ++ ++ ++ + +++
Hemorrhage - +++ ++++ + ++ + +++ ++ + - - +++
Edema - +++ + + + + +++ ++ + - - ++
Tubular Injury - +++ +++ + + + +++ + + - + +++
Tubulitis4 - - - - - - + - - - - +
Interstitial Infiltrate5 - - ­ - - - - - - - - +
Glomerulitis - - + + + - ++ - + - - ++
Endarteritis6 - - - - - - + - - - - ++
Immunofluorescence C4d PTC - - >50% - >50% - - - - 3–5% - -
Electron microscopy Peritubular Capillaries Endothelium Loss +++ ++ - - ++ - + ++
Activation ++ ++ + + ++ + + ++
Fibrin and/or platelets ++ ++ - - + - + +++
Cells RBC RBC - RBC RBC - - RBC, N
Glomeruli Endothelium Loss - ++ ++ NA + + + +
Activation + + ++ ++ + ++ ++
Foot process effacement 0 + + +++ + + +
1

No acute graft dysfunction.

2

Retransplanted under conventional therapy and stable at 6 yrs.

3

Developed TMA attributed to calcineurin inhibitor toxicity and currently on dialysis.

4

Tubulitis: -, none; + up to 2 lymphocytes/tubule;

5

Interstitial inflammation, -, none, +, up to 10%

6

Arteritis: +, one artery, ++ more than one artery.

Abbreviations: ATI, acute tubular injury; ACR2, acute cellular rejection, Banff type 2; AHR, acute humoral rejection; Bx: biopsy; PTC: peritubular capillary, TMA, thrombotic microangiopathy; RBC red blood cells, NA, not applicable, ATG, anti-thymocyte globulin; PE, plasmapheresis; N, neutrophils.