Chronic Rejection

Overview
  • Chronic Rejection is a pattern of host immune rejection of donor tisse.
Pathogenesis
  • Chronic Rejection occurs on timescales of months to years after organ transplant and is not attenuated by immunosuppressive therapy. Given its resistance to pharmacological treatment by immunosuppressive drugs and the general lack of inflammation in chronically rejected organs, it is likely that non-immune mechanisms are largely responsible for this pattern of rejection. In some sense chronic rejection may represent an inappropriate activation of wound healing pathways within the transplanted organ.
Pathology
  • Histologically, the chronically rejected organ will display proliferative arteriosclerosis along with atrophy and fibrosis of the parenchyma. Notably, there is little in the way of inflammation within the transplanted organ.
Clinical Consequences
  • The chronically rejected organ will display a slow, inexorable loss of function.