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Intimal arteritis in renal allografts

new takes on an old lesion

Bagnasco, Serena M.a; Kraus, Edward S.b

Current Opinion in Organ Transplantation: June 2015 - Volume 20 - Issue 3 - p 343–347
doi: 10.1097/MOT.0000000000000186
PATHOLOGY: Edited by Mark Haas

Purpose of review Inflammation of the arterial wall has been recognized as a key element of rejection since the early studies of pathologic changes in transplanted organs. Better elucidation of the mechanisms involved in endothelial injury has brought increasing complexity to the diagnostic classification of this lesion in the context of transplantation, and has affected the clinical management of patients with allograft rejection. Here, we examine how our understanding of the significance of intimal arteritis in renal graft biopsies has evolved in the past decades.

Recent findings Recognition that antidonor antibody may cause intimal arteritis has prompted revision of histologic classifications of transplant rejection. Although molecular signatures/biomarkers are being developed and proposed as new tools for aiding in the identification of cell-mediated and antibody-mediated types of rejection, histological examination is still needed to identify intimal arteritis in allograft biopsies. Outcome studies are contributing to clarify the prognostic significance of intimal arteritis in transplant rejection.

Summary Intimal arteritis remains an important histologic feature of allograft rejection, which comes in different nuances requiring tailored therapeutic approaches.

aDepartment of Pathology

bDepartment of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA

Correspondence to Serena M. Bagnasco, MD, Associate Professor of Pathology, Director, Clinical Renal Biopsy Service, Johns Hopkins School of Medicine, Ross 632, 720 Rutland Avenue, Baltimore, MD 21205, USA. Tel: +1 410 502 0812; fax: +410 502 0811; e-mail:

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