Immunohistological analysis of renal allograft biopsies from cyclosporin-treated patients. Induced HLA-class II antigen expression does not exclude a diagnosis of cyclosporin nephrotoxicity.
Differentiation of cyclosporin nephrotoxicity from renal allograft rejection is often difficult. Induction of tubular HLA-class II antigens and elevated levels of leucocyte infiltration are associated with allograft rejection but their association with cyclosporin nephrotoxicity is unclear. In order to determine these relationships, transplant biopsies (n = 32) from patients considered to have cyclosporin nephrotoxicity, allograft rejection or stable graft function were stained with monoclonal antibodies specific for HLA-class II antigens and infiltrating leucocytes. Leucocyte infiltration was elevated during rejection but not in cyclosporin nephrotoxicity or stable graft function. While HLA-class II antigen expression was induced in 71% of the biopsies obtained during clinical rejection, no increased expression was found in the other 29%. Induced antigens were detected in five of the nine biopsies obtained in the presence of cyclosporin nephrotoxicity 90 days after transplantation. In four of these, induction was attributed to prolongation of increased class II expression following previous rejection episodes. Thus, the presence of induced class II antigens in the renal allograft does not exclude a diagnosis of cyclosporin nephrotoxicity.
Fuggle
S V
SV
Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Headington, UK.
McWhinnie
D L
DL
Morris
P J
PJ
D000911:Antibodies, Monoclonal / Q000276:immunology; D001707:Biopsy, Needle; D002634:Chemotaxis, Leukocyte; D003404:Creatinine / Q000378:metabolism; D003524:Cyclosporins / Q000009:adverse effects*; D003937:Diagnosis, Differential; D006084:Graft Rejection / Q000276:immunology*; D006403:Hematologic Tests; D000949:Histocompatibility Antigens Class II / Q000096:biosynthesis*; D006801:Humans; D007124:Immunoenzyme Techniques; D007668:Kidney / Q000187:drug effects / Q000276:immunology*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology*; D013997:Time Factors
D000911:Antibodies, Monoclonal; D003524:Cyclosporins; D000949:Histocompatibility Antigens Class II; D003404:Creatinine