Department of Microbiology, School of Medicine, State University of New York at Buffalo, Buffalo, New York 14214.
J Exp Med. 1971 Sep 1;134(3):193-207.
Rejection of renal allografts in man and animals is most frequently induced by cell-mediated immunity, the morphologic hallmark of which is the infiltration of the graft by mononuclear cells. In some presensitized recipients rejection may be mediated by humoral transplantation antibodies, and this is characterized clinically by a rapid tempo of rejection and morphologically by accumulation of polymorphonuclear neutrophils and renal cortical necrosis. In recipients treated with immunosuppressive drugs, most renal allografts function well for over 1 yr. However, late deterioration is observed in many grafts. This may take the form of proliferative glomerulonephritis with accumulation of immunoglobulin and complement along glomerular basement membranes. This glomerular lesion of the graft may be of immunologic nature without being rejection. In many instances the glomerular lesion may be due to recurrence of the original disease of the recipient. In other instances it may represent a de novo immunologic process induced by the response to antigens shared by the graft and recipient as evidenced by animal experiments. The glomerular lesion in the graft may also be caused by humoral transplantation antibodies. Therefore, the final outcome of the renal transplantation may to a great extent depend on the strength of transplantation antibody response, being more favorable for low than high responders.
在人和动物中，排斥同种异体肾移植最常由细胞介导的免疫引起，其形态学特征是单核细胞浸润移植物。在一些预先致敏的受者中，排斥可能由体液性移植抗体介导，其临床特征是排斥迅速发生，形态学上表现为多形核白细胞和肾皮质坏死的积聚。在接受免疫抑制药物治疗的受者中，大多数肾移植在 1 年以上的时间内功能良好。然而，许多移植物会出现晚期恶化。这种情况可能表现为增生性肾小球肾炎，免疫球蛋白和补体沿肾小球基底膜积聚。这种移植物的肾小球病变可能具有免疫性质而不是排斥。在许多情况下，肾小球病变可能是由于受者的原有疾病复发引起的。在其他情况下，它可能代表由移植物和受者共享的抗原反应诱导的新的免疫过程，这已被动物实验证实。移植物中的肾小球病变也可能由体液性移植抗体引起。因此，肾移植的最终结果在很大程度上取决于移植抗体反应的强度，对于低反应者比高反应者更为有利。
