Cadaver versus living donor kidneys: impact of donor factors on antigen induction before transplantation.
BACKGROUND
It is widely recognized that living-related donor (LRD) renal allografts have a higher overall graft survival than cadaver donor transplants. We tested the hypothesis that part of this is attributable to LRD kidneys being obtained under optimal conditions from healthy donors, whereas cadaveric kidneys may have experienced injury as a result of inflammatory events around the time of brain death.


METHODS
We have performed a comparative immunohistochemical analysis of pretransplant donor biopsies from cadaveric (N = 65) and LRD (N = 29) kidneys to determine any differences that may predispose them to subsequent damage. Cryostat sections were stained with antibodies to leukocytes, adhesion molecules, and human leukocyte antigen (HLA)-DR antigens, and the expression was assessed semiquantitatively.


RESULTS
High levels of endothelial E-selectin and proximal tubular expression of HLA-DR antigens, intercellular adhesion molecule-1, and vascular cell adhesion molecule-1 were detected in biopsies from cadaveric kidneys, whereas expression of these markers was markedly reduced in LRD kidneys. High levels of tubular antigen expression were significantly associated with traumatic death, prolonged ventilation, and episodes of infection in cadaver donors. Furthermore, the expression of pretransplant tubular antigens in cadaver donor kidneys was significantly associated with early acute rejection following transplantation, suggesting that such kidneys are predisposed to subsequent immune-mediated attack following transplantation.


CONCLUSIONS
These results may explain, in part, the superior outcome of LRD allografts compared with cadaver renal allografts.
Koo
D D
DD
Nuffield Department of Surgery and Oxford Transplant Center, University of Oxford, John Radcliffe Hospital, England, United Kingdom.
Welsh
K I
KI
McLaren
A J
AJ
Roake
J A
JA
Morris
P J
PJ
Fuggle
S V
SV
D000328:Adult; D000911:Antibodies, Monoclonal; D001706:Biopsy; D002102:Cadaver; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage; D019040:E-Selectin / Q000032:analysis; D004727:Endothelium / Q000737:chemistry / Q000276:immunology / Q000378:metabolism; D005260:Female; D006085:Graft Survival / Q000187:drug effects / Q000276:immunology*; D006684:HLA-DR Antigens / Q000032:analysis / Q000378:metabolism; D000949:Histocompatibility Antigens Class II / Q000032:analysis* / Q000276:immunology / Q000378:metabolism; D006801:Humans; D007362:Intensive Care Units; D018799:Intercellular Adhesion Molecule-1 / Q000032:analysis / Q000378:metabolism; D016030:Kidney Transplantation / Q000276:immunology*; D007687:Kidney Tubules, Proximal / Q000737:chemistry / Q000276:immunology / Q000473:pathology; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D019007:P-Selectin / Q000032:analysis; D012076:Renal Agents / Q000008:administration & dosage; D014181:Transplantation Immunology; D014184:Transplantation, Homologous; D019010:Vascular Cell Adhesion Molecule-1 / Q000032:analysis / Q000378:metabolism
D000911:Antibodies, Monoclonal; D019040:E-Selectin; D006684:HLA-DR Antigens; D000949:Histocompatibility Antigens Class II; D019007:P-Selectin; D012076:Renal Agents; D019010:Vascular Cell Adhesion Molecule-1; D018799:Intercellular Adhesion Molecule-1; D003894:Deamino Arginine Vasopressin