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. 1994 Jul;24(1):72-7.
doi: 10.1016/s0272-6386(12)80162-4.

Allografts surviving for 26 to 29 years following living-related kidney transplantation: analysis by light microscopy, in situ hybridization for the Y chromosome, and anti-HLA antibodies

P S Randhawa  1 , T Starzl, H C Ramos, M A Nalesnik, J Demetris
Affiliations

Allografts surviving for 26 to 29 years following living-related kidney transplantation: analysis by light microscopy, in situ hybridization for the Y chromosome, and anti-HLA antibodies

P S Randhawa et al. Am J Kidney Dis. 1994 Jul.

Abstract

We studied seven patients aged 14 to 40 years who received living-related kidney transplants and had allograft survivals of 26 to 29 years. The blood urea and creatinine were either within normal limits or marginally elevated. Histopathologic examination showed only mild mesangial expansion, interstitial fibrosis, and arteriosclerosis. Immunoperoxidase staining with anti-HLA antibodies or in situ hybridization with a Y chromosome probe showed persistence of donor tubular epithelium and vascular endothelium within the graft. Recipient-derived glomerular cells were seen in one case, and interstitial lymphocytic infiltrates were seen in all cases. A review of the clinicopathologic data available for these cases indicated that both central and peripheral immunologic mechanisms contributed to the maintenance of prolonged graft survival. This extended survival was independent of six antigen matching, down-regulation of donor HLA antigen expression, and ingrowth of host epithelium/endothelium into the allograft.

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Figures

Fig 1
Fig 1
Morphologic alterations observed in a needle biopsy of the renal allograft in case no. 5. (A) The glomerulus is essentially unremarkable. (Magnification ×200.) (B) Minimal interstitial fibrosis was noted. (Magnification ×200.) (C) Electron microscopy showed a finely granular electron-lucent material deposited, at a subendothelial location, within the glomerular basement membranes. (Magnification ×5,400.)
Fig 2
Fig 2
Case no. 7 showed more pronounced histopathologic changes than those illustrated in Fig 1. (A) The glomeruli showed an accentuation of the lobular pattern and a segmental increase in the mesangial cellularity. The degree of interstitial fibrosis was greater than that observed in case no. 5. (Magnification ×200.) (B) The arteries showed fibrous thickening of the intimal layer. (Magnification ×100.)
Fig 3
Fig 3
(A) Demonstration of recipient-specific HLA A3 antigen expression by the interstitial mononuclear cells in case no. 1. (Magnification ×200.) (B) This patient was unusual in that some cells with the recipient phenotype had also infiltrated the glomeruli. (Magnification ×200.)
Fig 4
Fig 4
Needle biopsy of the allograft kidney in case no. 1 stained with the anti-HLA A2,69 antibody. Cells in the glomeruli (A) as well as the vascular endothelium (B) retained donor specificity 29 years after transplantation. (Magnification ×200.)
See this image and copyright information in PMC

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