Long-term allograft acceptance in a patient with posttransplant lymphoproliferative disorder: correlation with intragraft viral interleukin-10.
BACKGROUND
Viral (v) interleukin (IL)-10 is expressed by Epstein-Barr virus (EBV) and has pro- and anti-inflammatory actions similar to human IL-10. EBV is also a known factor in the development of posttransplant lymphoproliferative disorder (PTLPD) in allograft recipients. We observed a patient with widespread PTLPD 9 months after renal transplantation, who subsequently maintained renal function despite minimal immunosuppression, and we investigated a possible link between these factors.


METHODS
The patient's chart was reviewed for relevant history. EBV DNA in blood and tissues was assessed by polymerase chain reaction. Human and vIL-10 and gamma-interferon mRNA were evaluated with reverse transcription-polymerase chain reaction using nested primers.


RESULTS
After the diagnosis of PTLPD, the patient was maintained on prednisone (8 mg/day) as the only immunosuppression with preserved renal function for 17 months until death as a result of pulmonary failure. She had continuously high blood levels of EBV DNA, although only mild persistent intrarenal atypical lymphocytic infiltrates. Human IL-10 mRNA was never present; in contrast, intragraft vIL-10 mRNA was identified and associated with resolution of an intervening episode of severe acute transplant rejection.


CONCLUSIONS
We suggest that the preserved renal function resulted from the anti-inflammatory actions of vIL-10 inhibiting acute rejection in the renal allograft.
Nast
C C
CC
Department of Pathology, Cedars-Sinai Medical Center, and UCLA School of Medicine, Los Angeles, California 90048, USA.
Moudgil
A
A
Zuo
X J
XJ
Toyoda
M
M
Jordan
S C
SC
D000328:Adult; D004279:DNA, Viral / Q000032:analysis; D015536:Down-Regulation / Q000187:drug effects; D005260:Female; D006085:Graft Survival; D004854:Herpesvirus 4, Human / Q000235:genetics; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016753:Interleukin-10 / Q000235:genetics / Q000378:metabolism / Q000494:pharmacology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000209:etiology* / Q000503:physiopathology; D011241:Prednisone / Q000627:therapeutic use; D012333:RNA, Messenger / Q000032:analysis; D014412:Tumor Virus Infections / Q000150:complications / Q000635:transmission*
D004279:DNA, Viral; D007166:Immunosuppressive Agents; D012333:RNA, Messenger; D016753:Interleukin-10; D011241:Prednisone