RESUMEN
Composite tissue allotransplantation (CTA) is a novel transplantation discipline to treat functional tissue or limb defects. Since a majority of CTA grafts were vascularized grafts, it is also known as vascularized composite allotransplantation (VCA). The grafts of CTA/VCA consist of two or more types of allogeneic skin, subcutaneous tissue, bone, muscle, nerve and vessel, etc. Most of CTA/VCA grafts contain skin tissues, which possess the highest antigenicity. Acute rejection after transplantation is the primary obstacle leading to CTA/VCA graft failure and primary graft dysfunction. Hence, histopathological characteristics of skin rejection in CTA/VCA grafts have become the primary hotspot. In this article, pathological features of CTA/VCA rejection, Banff classification in 2007 and related research progress were reviewed, aiming to provide reference for the diagnosis and treatment of rejection and other complications of CTA/VCA.
RESUMEN
Objective: Our objective was to study the prevalence of thrombocytopenia & erythrocytopenia post renal transplantation in Eastern Indian population. Thrombocytopenia & erythrocytopenia are common phenomena prevailing post transplant rejection. It is found to occur in patients developing HCMV (human cytomegaloviral nephropathy), post transplantation. Whereas in the case of none rejected patients thrombocytopenia is unlikely to occur. Methods: Several methodologies such as the serological cross match, HLA-cross match DSA luminex, renal biopsy including C4d staining, hematological RBC & platelet count monitoring were adopted in the study, along with these the serum creatinine levels of the rejected patients were tested by making use of several biochemical approaches. Statistical analysis of the data obtained from the laboratories, were also done by the software prism 4.1. Results: Out of total population of 30 patients selected randomly, 24 were found to have successful transplants as for them a significant increase in both platelet & RBC count were noticed post transplantation where as for the other 6 patients a significant decrease in the RBC & platelet count was observed post transplantation along with a significant increase in the serum creatinine levels. There was also a significant decrease in the GFR (glomerular filtration rate) which was an indication of some sort of graft dysfunctioning. All the patients were checked for viral nephropathy & the above 6 patients were found to develop HCMV nephropathy. For the above mentioned 6 patients, the presence of C4d marker in their renal peritubular capillaries after performing the immunehistochemical C4d staining was a key indicator of acute antibody mediated rejection. Conclusion: Our study clearly reveals that Thrombocytopenia & erythrocytopenia was quite common in the patients with acute antibody mediated renal transplant rejection. A low RBC & platelet count persisted in them even after transplantation owing to allograft rejection, & HCMV nephropathy. Whereas for the patients with successful transplants events such as thrombocytopenia & erythrocytopenia were nevertheless unlikely.