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目的探讨移植肾失功的原因和移植肾血管病（ＡＲＡ）的发生机理。方法对７４例切除的无功能移植肾进行了临床病理分析，并应用免疫组织化学、免疫金电镜分别观察了２４例和５例发生ＡＲＡ的移植肾的形态。结果７４例无功能肾中急性排斥反应（ＡＲ）占８９．２％（６６／７４），慢性排斥反应（ＣＲ）占３６．５％（２７／７４）。ＡＲＡ的特征性形态为移植肾内动脉内膜呈向心性纤维性增厚，其中可见以Ｔ淋巴细胞为主的炎性细胞浸润；内皮细胞增生、肥大，并异常表达Ⅱ类主要组织相容性抗原（ＨＬＡＤ）。结论ＡＲ是造成移植肾无功能的最常见原因；ＡＲＡ是ＣＲ的特征性病变，ＡＲＡ可能是血管内皮损伤后Ｔ淋巴细胞介导的一种动脉内膜炎症
Objective To investigate the causes of graft failure and the mechanism of graft-versus-renal disease (ARA). Methods The clinicopathological features of 74 cases of resected non-functional graft kidney were analyzed. Immunohistochemistry and immunogold electron microscopy were used to observe the morphological changes of ARA in 24 cases and 5 cases respectively. Results The acute rejection (AR) in 74 cases of nonfunctional kidney accounted for 89.2% (66/74) and the chronic rejection (CR) accounted for 36.5% (27/74). The characteristic morphological features of ARA are as follows: central venous fibrosis of the grafted renal artery intimal thickening, inflammatory cells infiltrating mainly in T lymphocytes; endothelial cell proliferation, hypertrophy, and abnormal expression of type II major histocompatibility Antigen (HLA D). Conclusions AR is the most common cause of nonfunction of renal allograft. ARA is a characteristic lesion of CR. ARA may be an intimal hyperplasia mediated by T lymphocytes after vascular endothelial injury