Chronic rejection of a renal allograft is primarily mediated by:
- A Hyperacute antibody-mediated rejection due to pre-formed anti-ABO antibodies
- B Natural killer cell-mediated lysis of graft endothelial cells lacking self-MHC
- C Complement-mediated lysis triggered by drug-induced immune complex formation
- D Donor-specific antibodies (DSA) and T-cell mediated chronic immune injury to graft vasculature ✓
Explanation
Chronic allograft rejection (transplant glomerulopathy/chronic allograft nephropathy) results from ongoing donor-specific antibody (DSA) production targeting donor HLA antigens on graft endothelium, combined with chronic T-cell mediated immune injury. DSA activates complement (C4d deposition is a marker) and antibody-dependent cellular cytotoxicity, leading to intimal fibrosis, vascular narrowing, and eventual graft loss over years. Hyperacute rejection occurs within minutes and is due to pre-formed antibodies. NK cell killing is relevant in missing-self recognition but is not the primary chronic mechanism.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.