AECA may be important in the mediation of humoral AR, may decrease allograft survival, and may identify a high-risk group for CAV.

Ketamine, a dissociative anesthetic commonly used by US physicians, has recently been shown to be a powerful anti-depressant and is also capable of eliciting transpersonal experiences that can be transformative. Although currently approved in the US only for use as an anesthetic, physicians there can legally prescribe it off-label to treat various psychological/ psychiatric problems and it has been used for these non-anesthetic purposes in Argentina, Iran, Mexico, Russia, and the UK, as well as in the US. The literature on using ketamine psychotherapeutically is reviewed and two case studies using ketamine-enhanced psychotherapy (KEP) for treating death anxiety in terminally-ill people are reported. The potential importance of beginning formal research on using KEP during end-of-life for those suffering death anxiety is emphasized.

Damage to TBM develops in acute rejection as a consequence of interstitial inflammation and tubulitis. These lytic events correlate with the later development of clinical and morphologic evidence of chronic injury in the absence of arterial injury of chronic rejection. We suggest that chronic allograft nephropathy may have an inflammatory interstitial origin.

Conclusion. Damage to TBM develops in acute rejection asAcute rejection-associated tubular basement membrane changes a consequence of interstitial inflammation and tubulitis. These and chronic allograft nephropathy.lytic events correlate with the later development of clinical and Background. Acute rejection is a major risk factor for chronic morphologic evidence of chronic injury in the absence of arterial allograft nephropathy, although the link(s) between these events injury of chronic rejection. We suggest that chronic allograft is not understood. The hypothesis of this study is that alternephropathy may have an inflammatory interstitial origin. ations in tubular basement membranes (TBMs) that occur during acute rejection may be irreversible and thereby play a role in the development of chronic allograft nephropathy.Methods. Fourteen renal transplant patients were selected, Chronic rejection (CR) is the most common cause of each having had two or more biopsies performed (42 total). late-developing graft loss. The conventional view holds All biopsies were scored for acute and chronic rejection using Banff 1997 criteria. The initial biopsy showed only acute interthat CR has a vascular etiology [1-5]. Recently, attention stitial rejection (type I rejection). No biopsies contained sighas been directed toward interstitial contributions since nificant chronic arterial lesions of chronic vascular rejection.one of the strongest predictors of late graft failures isThe entire cortex was examined on Jones methenamine silverthe timing, number, and severity of acute rejection (AR) stained sections at ϫ400 for interruption in TBM staining. The episodes [5][6][7][8][9][10][11][12]. Even the presence of subclinical rejecnumber of tubules with TBM abnormalities was counted, and the renal cortical area was measured by image analysis. Periodic tion in early protocol biopsies, defined as the presence of acid-Schiff/immunoperoxidase stain was performed on 12 acute "borderline rejection" ("Banff 95"), has been associated rejection biopsies stained for laminin, cytokeratin 7, CD3, CD20,with elevated creatinine at one year compared with biopand CD68. Controls consisted of 11 biopsies (8 negative for sies free of all infiltrates [13][14][15]. The postulate of this rejection and 3 acute tubular necrosis).Results. Numerous TBM alterations in silver staining were