The Pathogenesis of the Vascular and Glomerular Lesions of Rejection in Renal Allografts and their Modification by Antithrombotic and Anticoagulant Drugs

Summary The pathogenesis of the vascular and glomerular lesions of allograft rejection has been studied in 254 percutaneous biopsies from patients who have received cadaveric allografts. Evidence is presented that thromboses and residual lesions following organisation of thrombi are the major changes in vessels and glomeruli in allograft rejection and that these lead to glomerular and vascular obliteration and graft failure. The ultramicroscopic features of the glomerular lesions are thought to be typical of intravascular thrombosis and similar to those seen in a variety of other conditions where thrombi develop in glomerular capillaries. Considerable modification of the vascular lesions was noted in patients treated early and continuously with dipyridamole combined with phenindione or heparin. The similarities between vascular and glomerular lesions in allograft rejection and a wide variety of other renal diseases is noted. On the basis of these findings it is suggested that antithrombotic and anticoagulant drugs may modify the many glomerular and vascular lesions including those of glomerulonephritis, hypertension, thrombotic microangiopathy and the collagen diseases all of which have features in common with those of allograft rejection.