Evaluation by histology, immunohistology and PCR of protocollized renal biopsies 1 week post-transplant in relation to subsequent rejection episodes.
Renal biopsies were performed 1 week following renal transplantation at a time without clinical evidence of rejection in 43 patients (13 females, mean age 48 years range 18-60 and 30 males, mean age 43 years range 17-59 years). Thirty-six biopsies were available for histological or immunohistochemical analysis. Immunohistochemical analyses were performed with monoclonal antibodies against leukocytes (CD45), monocytes (WT14), complement factor 3 (C3), T-cells (Leu4), T-cell receptor alpha beta and gamma delta, tumour necrosis factor alpha (TNF alpha), IL-2 receptor (IL2-R, TAC), intercellular adhesion molecule-1 (ICAM1) and HLA-DR. The slides were scored semiquantitatively with the observers having no knowledge of clinical or patient data. TNF alpha and IL-2R were also measured by quantative PCR. None of the studied parameters correlated to delayed graft function or graft loss. Histological analysis showed that both focal interstitial infiltrate (18/35) and tubular basement membrane disruption (11/35) were followed by a higher incidence of subsequent rejection (P = 0.03 and 0.02 respectively). Also positivity for WT14 around tubuli (P = 0.02) was associated with subsequent occurrence of rejection. The intensity of staining of ICAM-1 on PTC as well as TAC on proximal tubular cells was associated with the number of subsequent rejection episodes. The association between the IL-2 receptor and subsequent rejection was also found applying PCR to the tissue specimens. We conclude that the presence of focal interstitial infiltrates and tubulitis in 1-week biopsies from well-functioning grafts carries an increased risk of subsequent rejection.(ABSTRACT TRUNCATED AT 250 WORDS)
Kooijmans-Coutinho
M F
MF
Department of Nephrology, Leiden University Hospital, The Netherlands.
Bruijn
J A
JA
Hermans
J
J
Schindler
R
R
Frei
U
U
Schrama
E
E
van Es
L A
LA
Daha
M R
MR
van der Woude
F J
FJ
D015079:2-Isopropylmalate Synthase / Q000032:analysis; D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001483:Base Sequence; D001706:Biopsy; D016207:Cytokines / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D005656:Fungal Proteins / Q000032:analysis; D006084:Graft Rejection / Q000276:immunology / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D018799:Intercellular Adhesion Molecule-1 / Q000032:analysis; D007668:Kidney / Q000276:immunology / Q000473:pathology*; D007674:Kidney Diseases / Q000601:surgery; D016030:Kidney Transplantation / Q000276:immunology / Q000473:pathology*; D017493:Leukocyte Common Antigens / Q000032:analysis; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D029701:Saccharomyces cerevisiae Proteins; D013997:Time Factors; D014184:Transplantation, Homologous
D016207:Cytokines; D005656:Fungal Proteins; D029701:Saccharomyces cerevisiae Proteins; D018799:Intercellular Adhesion Molecule-1; D015079:2-Isopropylmalate Synthase; C080062:LEU4 protein, S cerevisiae; D017493:Leukocyte Common Antigens