title: Acute kidney graft rejection. A morphological and immunohistological study on "zero-hour" and follow-up biopsies with special emphasis on cellular infiltrates and adhesion molecules.
abstract: Serial biopsies from 41 consecutive renal allotransplanted patients were evaluated in order to obtain pretransplant data as well as information on well-functioning and acutely rejecting grafts. Each patient served as his own control. Thirty-five patients were followed according to the schedule which included biopsy prior to transplantation, shortly after opening of reanastomosis, at least once postoperatively (days 7-10), and furthermore whenever clinically indicated. The morphological evaluation was in each case combined with immunofluorescence (to detect immunoglobulins and complement fractions) and immunohistochemistry with a wide panel of monoclonal antibodies for T cells (CD2, CD3, CD4, CD8, gamma delta), B cells (CD20, CD22), macrophages (CD68, MAC387) NK cells (leu-7, CD16), activation markers (IL-2-R, Ki-67, transferrin-R), MHC antigens (HLA-ABC, HLA-DR), adhesion molecules (ICAM-1, VCAM-1, ELAM-1, PADGEM, VLA-4, LFA-1 alpha/beta), and growth factors (EGF, TGF-alpha, EGF-R). When 132 biopsies and 10 failed allografts were examined, no specific morphological or immunohistological parameter predictive of rejection or graft outcome could be found. Morphology in follow-up biopsies from non-rejecting and rejecting patients revealed a continuum of inflammatory changes, and several non-rejecting cases demonstrated cellular inflammatory infiltrates which could not be discriminated from those seen in acute rejection. Of the patients 44% had acute rejection accompanied by increased infiltration of T cells and macrophages showing enhanced IL-2-R expression, increased tubular and endothelial staining for MHC class II, ICAM-1, and VCAM-1, and strong leukocytic expression of VLA-4 and LFA-1 alpha/beta.
authors.affiliation: Department of Pathology, Herlev Hospital, University of Copenhagen, Denmark.
authors.forename: C B
authors.initials: CB
authors.lastname: Andersen
authors.forename: S D
authors.initials: SD
authors.lastname: Ladefoged
authors.forename: S
authors.initials: S
authors.lastname: Larsen
mesh_terms: D000293:Adolescent; D000328:Adult; D015703:Antigens, CD / Q000032:analysis / Q000276:immunology; D018951:Antigens, CD20; D000944:Antigens, Differentiation, B-Lymphocyte / Q000032:analysis / Q000276:immunology; D015214:Antigens, Differentiation, Myelomonocytic / Q000032:analysis / Q000276:immunology; D000945:Antigens, Differentiation, T-Lymphocyte / Q000032:analysis / Q000276:immunology; D001402:B-Lymphocytes / Q000276:immunology / Q000473:pathology / Q000648:ultrastructure; D018801:CD2 Antigens; D017252:CD3 Complex / Q000032:analysis / Q000276:immunology; D015704:CD4 Antigens / Q000032:analysis / Q000276:immunology; D016827:CD8 Antigens / Q000032:analysis / Q000276:immunology; D015815:Cell Adhesion Molecules / Q000032:analysis / Q000276:immunology; D002465:Cell Movement / Q000502:physiology; D002648:Child; D003165:Complement System Proteins / Q000032:analysis / Q000276:immunology; D004311:Double-Blind Method; D004815:Epidermal Growth Factor / Q000032:analysis; D005455:Fluorescent Antibody Technique; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000276:immunology / Q000473:pathology; D006680:HLA Antigens / Q000032:analysis / Q000276:immunology; D006801:Humans; D007136:Immunoglobulins / Q000032:analysis / Q000276:immunology; D007150:Immunohistochemistry; D018799:Intercellular Adhesion Molecule-1; D007668:Kidney / Q000737:chemistry / Q000276:immunology / Q000473:pathology; D016030:Kidney Transplantation / Q000276:immunology* / Q000473:pathology; D007694:Killer Cells, Natural / Q000276:immunology / Q000473:pathology; D037102:Lectins; D008264:Macrophages / Q000276:immunology / Q000473:pathology; D008875:Middle Aged; D017452:Receptors, IgG / Q000032:analysis / Q000276:immunology; D011971:Receptors, Immunologic / Q000032:analysis / Q000276:immunology; D015375:Receptors, Interleukin-2 / Q000032:analysis; D051918:Sialic Acid Binding Ig-like Lectin 2; D013601:T-Lymphocytes / Q000276:immunology / Q000473:pathology / Q000648:ultrastructure; D013997:Time Factors; D014184:Transplantation, Homologous; D000097382:CD68 Molecule
chemical_list: D015703:Antigens, CD; D018951:Antigens, CD20; D000944:Antigens, Differentiation, B-Lymphocyte; D015214:Antigens, Differentiation, Myelomonocytic; D000945:Antigens, Differentiation, T-Lymphocyte; D018801:CD2 Antigens; D017252:CD3 Complex; D015704:CD4 Antigens; D016827:CD8 Antigens; D015815:Cell Adhesion Molecules; D003165:Complement System Proteins; D004815:Epidermal Growth Factor; D006680:HLA Antigens; D007136:Immunoglobulins; D018799:Intercellular Adhesion Molecule-1; D037102:Lectins; D017452:Receptors, IgG; D011971:Receptors, Immunologic; D015375:Receptors, Interleukin-2; D051918:Sialic Acid Binding Ig-like Lectin 2; C497867:CD22 protein, human; C067980:CD68 antigen, human; D000097382:CD68 Molecule