Local events in graft rejection.

It appears that allograft rejections can be considered as a series of cellular and molecular cascades of inflammation triggered by the immune response. In acute rejection, inflammatory changes with a prominent blast cell component dominate. The main result is toxic damage of several parenchymal components, particularly the microvascular endothelium, resulting in necrosis of the parenchyma and loss of the allograft within days after transplantation. In the chronic type of rejection, inflammation also exists, but the major manifestations are different. Adventitial inflammation and perivascular cuffing of leukocytes result in concentric intimal proliferation and atherosclerosis. Very little experimental data exist, at present, on the mechanisms of transplant atherosclerosis and chronic rejection.