title: Analysis of urinary donor-derived DNA in renal transplant recipients with acute rejection.
abstract: In renal transplantation we usually diagnose an acute rejection by based on the results of a needle biopsy; however, this takes time and findings in some cases are not definite. We analysed the urine of renal recipients for the presence of donor DNA in an attempt to establish a diagnostic means of acute rejection. Sixty-four renal transplant recipients were examined. Thirty-seven patients had no trouble after transplantation and 22 patients developed acute rejection, diagnosed based on serum creatinine levels and/or needle biopsy findings of the graft. Five patients had drug-induced renal dysfunction. In female recipients with a male graft we examined urine for the presence of Y-chromosome (SRY and DYZ-1) and in recipients receiving a HLA mismatched graft we investigated the HLA-DR gene (DRB1) by the polymerase chain reaction (PCR) method. Among female recipients with a male graft there were 14 patients with stable renal function and SRY and DYZ-1 on Y-chromosome were negative in 13 (93%) and positive in one, whereas SRY and DYZ-1 of urine were positive in the four female patients with acute rejection and these DNA fragments disappeared in three after rejection therapy. One patient was subjected to haemodialysis. Among 23 recipients of a graft from HLA mismatched donors with stable renal function, DRB1 was negative in 21(91%). Among 18 patients with acute rejection DRB1 was positive in 16 (93%) and negative in two. These DNA fragments disappeared in 13 patients after rejection therapy. In all patients with drug-induced renal dysfunction donor-derived DNA was negative. Presence of donor-specific DNA in the urine of the recipient is associated strongly with acute rejection and analysis of DNA derived from donor cells in urine might be an effective and accurate method for the diagnosis of acute rejection of a renal transplant.
authors.affiliation: Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, Sendai, Japan.
authors.forename: Zhihong
authors.initials: Z
authors.lastname: Zhang
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Ohkohchi
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Sakurada
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Mizuno
authors.forename: Shigehito
authors.initials: S
authors.lastname: Miyagi
authors.forename: Susumu
authors.initials: S
authors.lastname: Satomi
authors.forename: Masaaki
authors.initials: M
authors.lastname: Yamaguchi
authors.forename: Hajime
authors.initials: H
authors.lastname: Okazaki
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D041322:Chromosomes, Human, Y; D004247:DNA / Q000652:urine*; D005260:Female; D024282:Genes, sry / Q000235:genetics; D006084:Graft Rejection / Q000175:diagnosis* / Q000235:genetics; D006684:HLA-DR Antigens / Q000032:analysis; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D014019:Tissue Donors
chemical_list: D006684:HLA-DR Antigens; D004247:DNA