Subclinical Rejection

FIGURE 10-18 (see Color Plate)

Subclinical rejection. Subclinical rejection characterized by moderate to severe tubulitis may be found in as many as 35% of normally functioning grafts. Far from representing false-positive readings, such findings now appear to represent bona fide smoldering rejection that, if left untreated, is associated with increased incidence of chronic renal functional impairment and graft loss [10,11]. The important debate for the future is when to perform protocol biopsies to identify subclinical rejection and how best to treat it. This picture shows severe tubulitis in a normally functioning graft 15 months after transplantation. In the tubule in the center are 30 lymphocytes (versus 14 tubule cells). A year and a half later the patient developed renal functional impairment.

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