A microangiographic study of 17 rejected and surgically removed human kidney transplants, three transplants removed for other reasons and two adequately perfused and preserved but not transplanted cadaver kidneys was performed. Transplants rejected with acute clinical course showed poor or variable glomerular filling and tapering cortical arteries with no impairment of medullary perfusion, more extensively in those transplants showing poor initial function. Chronic rejection, independent of other parameters showed lack of cortical perfusion, and glomerular filling; impaired perfusion of whole segments, arterial wall narrowing and changes secondary to kidney shrinkage. The radiographic patterns of chronic and acute rejection were distinguishable from each other and from nonrejected specimens.
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