FIGURE 10-20 (see Color Plate)

Peritubular capillary basement membrane ultrastructural changes, A, and staining for VCAM-1 as specific markers for chronic rejection, B [14-16]. Splitting and multilayering of peritubular capillary basement membranes by electron microscopy holds promise as a relatively specific marker for chronic rejection [14,15]. VCAM-1 staining by immunohistology in these same structures may also be of diagnostic utility [16]. Ongoing studies of large numbers of patients using these parameters will test the value of these parameters which may eventually be added to the Banff classification. A, Multilayering of peritubular capillary basement membrane in a case of chronic rejection; B, shows staining of peritubular capillaries for VCAM-1 by immunoperoxidase in chronic rejection.

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