Chronic humoral rejection is characterized by the presence of anti-HLA belonging to class I or class II and these can emanate from the donor or from the recipient. Transplant arteriopathy is also a common finding and it presents in form of narrowed and closure of the medium and large arteries as a result of fibrointimal proliferation. When glomerular injury occurs, it is possible to tell since pronounced proteinuria and mesangial expansion can accompany it.
In addition, transplant glomerulopathy is signified by the presence of HLA antibodies which are specifically from the donor or from the patient if the patient had suffered acute humoral rejection in the past. It is noted that the prognosis of CHR involving transplant glomerulopathy is usually poor and the chance of the graft surviving is reduced by half within the first three years after the transplant. There are three main elements that are used as a diagnosis guide for CHR.
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