Early Graft Loss after Kidney Transplantation: Endothelial Dysfunction of Renal Microvasculature

Figure 1

Light microscopy of kidney graft biopsy: magnification 400x; periodic acid Schiff (PAS) stain; chloroacetate esterase (CAE) stain. (a) Biopsy from average deceased donor. PAS: unremarkable glomerulus and mild acute tubular injury: proximal tubules show epithelial attenuation and focal vacuolization. The lumens appear dilated due to thinning of apical cytoplasm and focal loss of apical brush borders. CAE: in some glomeruli, there is up to one neutrophil (0-1, average 0.4). (b) Biopsy from deceased donor exposed to ECMO. PAS: mild acute tubular injury, similar to average preimplantation biopsy. Light microscopy showed unremarkable glomerulus with some neutrophil granulocytes. CAE: special stain revealed intraglomerular neutrophils, up to 6/ glomerulus (1-6, average 3). Sparse neutrophils are also in peritubular capillaries. In small artery above glomerulus, endothelial cells appear shrunken and detached. (c) Biopsy from deceased donor exposed to Takatsubo cardiomyopathy. PAS: mild acute tubular injury, similar to average preimplantation biopsy. Light microscopy shows unremarkable glomerulus. CAE: special stain revealed intraglomerular neutrophils, up to 2/ glomerulus (0-2, average 0.8). Sparse neutrophils are also in arterioles and peritubular capillaries.

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