This volume in the Diagnostic Pathology series is an ideal point-of-care resource for practitioners at all levels of experience and training. Covering the full range of solid organ transplantation (SOT) of the kidney, liver, heart, lung, pancreas, intestine, and more, it provides a current understanding of transplant immunology and pathology to help ensure accurate diagnosis for optimal clinical management. Richly illustrated and easy to use, Diagnostic Pathology:: Transplant Pathology, third edition, is a visually stunning, one-stop reference for practicing pathologists, transplant practitioners, and students of organ transplantation.
4 Immune Response in Organ Transplantation Roshini Sarah Abraham, PhD 8 Regulatory Immune Cells and Transplant Tolerance Roshini Sarah Abraham, PhD 14 Viral Infections and Immune Response Sanya J. Thomas, MD and Roshini Sarah Abraham, PhD 20 Genetics of Complement Variants in Atypical HUS and TMA Roshini Sarah Abraham, PhD 24 Laboratory-Based Immune Monitoring in Organ Transplantation Sanya J. Thomas, MD and Roshini Sarah Abraham, PhD 30 Introduction to Xenotransplantation Roshini Sarah Abraham, PhD 32 Graft-vs.-Host Disease in Solid Organ Transplantation Sanya J. Thomas, MD and Roshini Sarah Abraham, PhD
SECTION2: HLA TESTING
36 Human Leukocyte Antigen System Manish J. Gandhi, MD 38 Histocompatibility Testing Manish J. Gandhi, MD 40 Transplantation and HLA Manish J. Gandhi, MD 44 ABO Blood Group Antigens and Transplantation Manish J. Gandhi, MD 46 Apheresis and Transplantation Manish J. Gandhi, MD 48 HLA and Transfusion Manish J. Gandhi, MD
SECTION 3: IMMUNOSUPPRESSIVE DRUGS
52 Mechanism of Action of Immunosuppressive Drugs Loralie Langman, PhD and Florian Lemaitre, PharmD, PhD 54 Therapeutic Drug Monitoring in Transplant Patients Loralie Langman, PhD and Florian Lemaitre, PharmD, PhD 58 History of Immunosuppression Drugs in Transplantation Loralie Langman, PhD and Florian Lemaitre, PharmD, PhD
SECTION 4: KIDNEY TRANSPLANTATION
62 History of Kidney Transplantation Lynn D. Cornell, MD 64 Pathologic Classification of Renal Allograft Diseases Robert B. Colvin, MD 66 Examination of End-Stage Kidney Shane Meehan, MB, BCh 72 Evaluation of End-Stage Kidney Shane Meehan, MB, BCh 78 Evaluation of Allograft Kidney Lynn D. Cornell, MD and Evan Farkash, MD, PhD 84 Evaluation of Donor Kidney Lynn D. Cornell, MD and Evan Farkash, MD, PhD 90 Evaluation of Transplant Nephrectomy Shane Meehan, MB, BCh and Evan Farkash, MD, PhD 94 Evaluation of Fibrosis A. Brad Farris, III, MD, MBA 98 Protocol Biopsies Lynn D. Cornell, MD and Evan Farkash, MD, PhD 102 Accommodation Lynn D. Cornell, MD 104 Tolerance Robert B. Colvin, MD
SURGICAL COMPLICATIONS
108 Acute Allograft Ischemia A. Brad Farris, III, MD, MBA 112 Size Mismatch Allograft Injury Anthony Chang, MD and Yael K. Heher, MD, MPH 114 Urine Leak A. Brad Farris, III, MD, MBA 115 Lymphocele A. Brad Farris, III, MD, MBA 116 Multinucleated Endotheliopathy Jonathan Zuckerman, MD, PhD 120 Transplant Renal Artery Stenosis A. Brad Farris, III, MD, MBA 122 Transplant Renal Artery or Vein Thrombosis A. Brad Farris, III, MD, MBA 124 Kidney Xenografts Ivy A. Rosales, MD
ALLOGRAFT REJECTION
128 Hyperacute Rejection Lynn D. Cornell, MD and Michael Mengel, MD 132 Acute T-Cell-Mediated Rejection Lynn D. Cornell, MD and Michael Mengel, MD 142 Chronic T-Cell-Mediated Rejection Lynn D. Cornell, MD and Michael Mengel, MD 146 Acute Antibody-Mediated Rejection Lynn D. Cornell, MD and Michael Mengel, MD 154 Chronic Antibody-Mediated Rejection Lynn D. Cornell, MD and Michael Mengel, MD 166 Transcript Analysis of Renal Transplant Biopsies Michael Mengel, MD and R. Neal Smith, MD, PhD
RECURRENT AND DE NOVO DISEASES
170 Diseases That Recur in Allografts Anthony Chang, MD, Lynn D. Cornell, MD, and R. Neal Smith, MD, PhD 176 De Novo Focal Segmental Glomerulosclerosis Anthony Chang, MD and Astrid Weins, MD, PhD 178 De Novo Membranous Nephropathy Anthony Chang, MD 182 Anti-GBM Disease in Alport Syndrome Anthony Chang, MD and R. Neal Smith, MD, PhD 184 Chimerism Transition Syndrome A. Brad Farris, III, MD, MBA 186 Late Posttransplant Histology Lynn D. Cornell, MD
KIDNEY PATHOLOGY OF RECIPIENTS OF OTHER TRANSPLANTS
188 Kidney Diseases in Nonrenal Transplant Recipients Robert B. Colvin, MD 192 Graft-vs.-Host Glomerulopathies Anthony Chang, MD and Yael K. Heher, MD, MPH
202 Acute Pyelonephritis Neeraja Kambham, MD 210 Polyomavirus Nephritis Anthony Chang, MD and Evan Farkash, MD, PhD 218 Adenovirus Infection Anthony Chang, MD and R. Neal Smith, MD, PhD 220 Cytomegalovirus Infection Anthony Chang, MD and R. Neal Smith, MD, PhD 222 Mucormycosis Anthony Chang, MD 224 Histoplasmosis Anthony Chang, MD 225 Candidiasis Anthony Chang, MD 226 Cryptococcosis Anthony Chang, MD 227 Aspergillosis Anthony Chang, MD 228 Coccidioidomycosis Anthony Chang, MD 229 Paracoccidioidomycosis Anthony Chang, MD 230 Microsporidiosis Robert B. Colvin, MD 232 Tuberculosis Neeraja Kambham, MD 234 Malakoplakia Neeraja Kambham, MD 238 Nocardiosis Neeraja Kambham, MD
SECTION 5: LIVER TRANSPLANTATION
242 Pathologic Classification of Liver Allograft Diseases Lindsay Alpert, MD and John Hart, MD 244 Gross Evaluation of Native Liver Lindsay Alpert, MD and John Hart, MD 248 Evaluation of Failed Liver Allograft Lindsay Alpert, MD and John Hart, MD 250 Evaluation of Donor Liver John Hart, MD 254 History of Liver Transplantation Anthony Chang, MD and John Hart, MD
POSTTRANSPLANT SURGICAL COMPLICATIONS
256 Preservation Injury Hanlin L. Wang, MD, PhD 258 Hepatic Artery Thrombosis Lisa Yerian, MD and John Hart, MD 260 Portal Vein Thrombosis Lisa Yerian, MD and John Hart, MD 262 Bile Duct Stricture, Leak, Sludge, Biloma Hanlin L. Wang, MD, PhD 264 Hepatic Venous Outflow Obstruction Hanlin L. Wang, MD, PhD 268 Small-for-Size (Hyperperfusion) Syndrome Hanlin L. Wang, MD, PhD
ALLOGRAFT REJECTION
270 T-Cell-Mediated Rejection, Liver Lisa Yerian, MD and John Hart, MD 274 Antibody-Mediated Rejection, Liver Hanlin L. Wang, MD, PhD, Robert B. Colvin, MD, and Richard Masia, MD, PhD 278 Chronic (Ductopenic) Rejection Matthew M. Yeh, MD, PhD and John Hart, MD
RECURRENT DISEASES IN LIVER ALLOGRAFT
280 Recurrent Hepatitis B Virus Lindsay Alpert, MD and John Hart, MD 282 Recurrent Hepatitis C Virus Lindsay Alpert, MD and John Hart, MD 286 Fibrosing Cholestatic HBV or HCV Hepatitis Lindsay Alpert, MD and John Hart, MD 288 Recurrent Autoimmune Hepatitis Lindsay Alpert, MD and John Hart, MD 290 Recurrent Primary Biliary Cholangitis Lindsay Alpert, MD and John Hart, MD 292 Recurrent Primary Sclerosing Cholangitis Lindsay Alpert, MD and John Hart, MD 294 Recurrent Fatty Liver Disease Lindsay Alpert, MD and John Hart, MD
INFECTIONS
296 Cytomegalovirus Maria Westerhoff, MD and Lei Zhao, MD, PhD 298 Herpes Simplex Virus Maria Westerhoff, MD and Lei Zhao, MD, PhD 300 Adenovirus, Liver Maria Westerhoff, MD and Lei Zhao, MD, PhD 302 Hepatitis E Virus Maria Westerhoff, MD and Lei Zhao, MD, PhD 304 Epstein-Barr Virus, Liver Maria Westerhoff, MD and Lei Zhao, MD, PhD 308 Fungal Infections, Liver Maria Westerhoff, MD and Lei Zhao, MD, PhD
LATE-GRAFT DYSFUNCTION
310 Plasma Cell-Rich Rejection Lisa Yerian, MD and John Hart, MD 312 Graft-vs.-Host Disease, Liver Lisa Yerian, MD and John Hart, MD
SECTION 6: HEART TRANSPLANTATION
316 Pathologic Classification of Cardiac Allograft Diseases Phillip D. McMullen, MD, PhD and Aliya N. Husain, MD 318 Evaluation of Failed Native and Transplanted Heart Aliya N. Husain, MD and Phillip D. McMullen, MD, PhD 320 History of Heart Transplantation Phillip D. McMullen, MD, PhD and Aliya N. Husain, MD
EVALUATION OF EXPLANTED HEART
322 Ischemic Heart Disease Phillip D. McMullen, MD, PhD and Aliya N. Husain, MD 326 Dilated Cardiomyopathy Phillip D. McMullen, MD, PhD and Aliya N. Husain, MD 330 Hypertrophic Cardiomyopathy Phillip D. McMullen, MD, PhD and Aliya N. Husain, MD 334 Congenital Heart Disease Phillip D. McMullen, MD, PhD and Aliya N. Husain, MD 338 Sarcoidosis, Heart Phillip D. McMullen, MD, PhD and Aliya N. Husain, MD 340 Arrhythmogenic Cardiomyopathy Phillip D. McMullen, MD, PhD and Aliya N. Husain, MD 344 Other Causes of End-Stage Heart Disease Phillip D. McMullen, MD, PhD and Aliya N. Husain, MD
ALLOGRAFT REJECTION
350 Acute Cellular Rejection, Heart Phillip D. McMullen, MD, PhD and Aliya N. Husain, MD 354 Antibody-Mediated Rejection, Heart Phillip D. McMullen, MD, PhD and Aliya N. Husain, MD 356 Chronic Allograft Vasculopathy, Heart Phillip D. McMullen, MD, PhD and Aliya N. Husain, MD
NONINFECTIOUS LESIONS
358 Quilty Lesions Phillip D. McMullen, MD, PhD and Aliya N. Husain, MD 360 Site of Previous Biopsy Phillip D. McMullen, MD, PhD and Aliya N. Husain, MD
INFECTIONS
362 Myocarditis Phillip D. McMullen, MD, PhD and Aliya N. Husain, MD
SECTION 7: LUNG TRANSPLANTATION
370 Pathologic Classification of Lung Allograft Diseases Jefree J. Schulte, MD and Aliya N. Husain, MD 372 Examination of Native and Transplanted Lungs Jefree J. Schulte, MD and Aliya N. Husain, MD 374 History of Lung Transplantation Jefree J. Schulte, MD and Aliya N. Husain, MD
EVALUATION OF FAILED NATIVE LUNG
376 Emphysema Jefree J. Schulte, MD and Aliya N. Husain, MD 378 Cystic Fibrosis Jefree J. Schulte, MD and Aliya N. Husain, MD 380 Idiopathic Pulmonary Fibrosis Jefree J. Schulte, MD and Aliya N. Husain, MD 382 Connective Tissue Disease-Associated Interstitial Lung Disease Jefree J. Schulte, MD and Aliya N. Husain, MD 384 Sarcoidosis, Lung Jefree J. Schulte, MD and Aliya N. Husain, MD 386 Pulmonary Arterial Hypertension Jefree J. Schulte, MD and Aliya N. Husain, MD 388 Other Causes of End-Stage Lung Disease Jefree J. Schulte, MD and Aliya N. Husain, MD
SURGICAL COMPLICATIONS
392 Surgical Aspects and Complications, Lung Jefree J. Schulte, MD and Aliya N. Husain, MD
ALLOGRAFT REJECTION
394 Pathologic Classification of Rejection Jefree J. Schulte, MD and Aliya N. Husain, MD 396 Antibody-Mediated Rejection, Lung Jefree J. Schulte, MD and Aliya N. Husain, MD 398 Acute Cellular Rejection, Grade A Jefree J. Schulte, MD and Aliya N. Husain, MD 400 Acute Cellular Rejection, Grade B Jefree J. Schulte, MD and Aliya N. Husain, MD 402 Chronic Allograft Dysfunction, Lung Jefree J. Schulte, MD and Aliya N. Husain, MD
NONINFECTIOUS LESIONS
404 Organizing Pneumonia Jefree J. Schulte, MD and Aliya N. Husain, MD 406 Microaspiration Jefree J. Schulte, MD and Aliya N. Husain, MD
INFECTIONS
408 Bacterial Infections Jefree J. Schulte, MD and Aliya N. Husain, MD 410 Viral Infections Jefree J. Schulte, MD and Aliya N. Husain, MD 414 Fungal Infections, Lung Jefree J. Schulte, MD and Aliya N. Husain, MD
SECTION 8: INTESTINAL TRANSPLANTATION
420 Pathologic Classification of Intestinal Allograft Diseases Sarangarajan Ranganathan, MD 422 Indications and Evaluation of Explant Sarangarajan Ranganathan, MD 426 Reperfusion Injury Sarangarajan Ranganathan, MD 430 History of Intestinal and Multivisceral Transplantation Sarangarajan Ranganathan, MD
480 Pathologic Classification of Pancreas Allograft Diseases Surya V. Seshan, MD and Billie S. Fyfe, MD 482 Clinical Considerations in Pancreas Transplant Evaluation Surya V. Seshan, MD and Billie S. Fyfe, MD 488 History of Pancreas Transplantation Surya V. Seshan, MD and Billie S. Fyfe, MD 490 History of Islet Transplantation Piotr Witkowski, MD, PhD and Sarah A. Gondek, BS
SURGICAL COMPLICATIONS
492 Surgical Aspects and Complications, Pancreas Piotr Witkowski, MD, PhD, Sarah A. Gondek, BS, and Surya V. Seshan, MD
ALLOGRAFT REJECTION
500 T-Cell-Mediated Rejection, Pancreas Surya V. Seshan, MD, Billie S. Fyfe, MD, and Erika R. Bracamonte, MD 506 Antibody-Mediated Rejection, Pancreas Surya V. Seshan, MD and Billie S. Fyfe, MD 510 Pancreas Allograft Fibrosis/Graft Sclerosis Surya V. Seshan, MD, Billie S. Fyfe, MD, and Erika R. Bracamonte, MD
GRAFT DYSFUNCTION
514 Recurrent Diabetes Mellitus Surya V. Seshan, MD and Billie S. Fyfe, MD 518 Islet Cell Toxicity and Islet Amyloid Deposition Surya V. Seshan, MD and Billie S. Fyfe, MD
INFECTIONS
520 Intraabdominal and Opportunistic Infections Surya V. Seshan, MD and Billie S. Fyfe, MD
528 History of Vascularized Composite Allotransplantation Linda Cendales, MD, J. Andres Hernandez, MD, MBA, and Emmanuel O. Emovon, III, BS 530 Complications of Vascularized Composite Allotransplantation Linda Cendales, MD, J. Andres Hernandez, MD, MBA, and Emmanuel O. Emovon, III, BS
ALLOGRAFT REJECTION
532 Acute T-Cell- and Antibody-Mediated Rejection A. Brad Farris, III, MD, MBA, Ivy A. Rosales, MD, and Robert B. Colvin, MD 540 Chronic Rejection A. Brad Farris, III, MD, MBA, Robert B. Colvin, MD, and Ivy A. Rosales, MD
SECTION 11: POSTTRANSPLANT NEOPLASTIC DISORDERS
544 Posttransplant Lymphoproliferative Diseases A. Brad Farris, III, MD, MBA
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