Dr. Fairuz Quzwain, SpPA, M.

Kes
Bagian Patologi Anatomi
Program Studi Pendidikan Dokter
Universitas Jambi
 A Major barrier to transplantation is the process of
rejection

Rejection the recepients immune system

recognizes the graft as being foreign and attacks it

Skin, Kidneys, heart, lungs, liver, spleen, bone marrow

and endocrine organs.
Mechanisms
The antigens responsible for such rejection in humans
are those of the HLA system

Every individual will recognize some HLA molecules

in another individual as foreign

Rejection is a complex process in which both cell-

mediated immunity and circulating antibodies play a
role
T cell-mediated Reaction
Called cellular rejection

Induced by 2 mechanism :
1. destruction of graft cells by CD8+ CTLs
2. delayed hypersensitivity by CD4+ helper

The recipients T cell recognize antigens in graft bay 2

pathways, called direct and indirect
 The direct pathway is the major pathway in acute
cellular rejection, whereas the indirect pathway is
more important in chronic rejection.
Antibody-mediated Reaction
Called humoral rejection

Hyperacute rejection occurs when preformed antidonor

antibodies are present in the circulation of the recipient.
- Kidney transplantation
- Blood transfusions

When preformed antidonor antibodies are present,

rejection occurs immediately after transplantation because
the circulating antibodies react with and deposit rapidly on
the vascular endothelium of the grafted organ
 Complement fixation occurs, resulting in thrombosis
of vessels in the graft and ischemic death of the graft.
The initial target of these antibodies in rejection
appears to be the graft vasculature vasculitis
Morphology
On the basis of the morphology and the underlying
mechanism, rejection reactions are classified as :
Hyperacute, Acute , and Chronic
Hyperacute :
- Occurs within minutes or hours
- Ig and Compl are deposited in the vessel wall
( endothelium)
- ex. Kidney : cyanotic, mottled, flaccid, excretes mere
few drops of bloody urine
 Acute :
- Occurs within days in the untreated recipient or may
appear suddenly months or even years later after
immunosupression has been employed and
terminated
- Vasculitis, interstitial mononuclear cell infiltrate
Chronic :
- in recent years, acute rejection has been significantly
controlled by immunosupressive therapy, and chronic
rejection has emerged as an important cause of graft
failure.
- Dominated by vascular changes, intstitial fibrosis and
atrophy.
- The vascular changes consist of dense, obliterative
intimal fibrosis.
Increasing Graft Survival
Minimizing the HLA disparity between the donor and
the recipient would be expected to improve graft
survival.
Immunosupressive therapy cyclosporine