Rejection Processes in Human Homotransplanted Kidneys

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Abstract
In a series of 13 consecutive cases of human kidney transplantation, 7 suffered vascular damage which led to renal failure. The cases have been arranged in order of duration of survival in order to illustrate the probable sequence and variety of lesions. The vascular lesions found in these homotransplanted kidneys differ from any naturally occurring human arterial disease. The earliest stage has a type of cell reaction and intimal damage not seen before. A differentiation has been made from periarteritis nodosa and scleroderma, but an immunological reaction of some sort is believed to be involved. Clinical and pathological reasons have been given which allow a differentiation from the vascular lesion of malignant hypertension. An attempt has been made to unify the classical cellular lesion and the vascular lesion. The feature common to both lesions is damage to vascular endothelium by circulating plasma-cell precursors. Parenchymal damage is secondary to vascular lesions. The vascular lesions vary in severity and with the length of survival and also with the size of vessel. In all cases, the interlobular arteries were the most severely affected and the largest arteries the least so. The onset of the vascular lesion did not give rise to the alarming signs associated with cellular rejection (toxic syndrome). Accordingly the rejection process was irreversible because it was well established by the time signs of renal failure occurred. In the whole series of 13 cases, the longest survivals received X-irradiation and the shortest survivals immunosuppressive drugs.