Figure 108

Diagram of arterial lesions of acute rejection. The initial changes (1-5) before intimal arteritis (6) occurs are completely nonspecific. These early changes are probably mechanistically related to the diagnostic lesions but can occur as a completely self-limiting phenomenon unrelated to clinical rejection. Lesions 7 to 10 are those characteristic of "transmural" rejection. Lesion 1 is perivascular inflammation; lesion 2, myocyte vacuolization; lesion 3, apoptosis; lesion 4, endothelial activation and prominence; lesion 5, leukocyte adherence to the endothelium; lesion 6 (specific), penetration of inflammatory cells under the endothelium (intimal arteritis); lesion 7, inflammatory cell penetration of the media; lesion 8, necrosis of medial smooth muscle cells; lesion 9, platelet aggregation; lesion 10, fibrinoid change; and lesion 11 is thrombosis.

J. W 'jM

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