The absence of delayed graft function is predicted by the presence of manganese-superoxide dismutase in distal tubules of renal allografts.
BACKGROUND
Acute tubular necrosis (ATN) in renal allograft biopsies correlates poorly with delayed graft function (DGF). Factors involved in the pathogenesis of DGF were evaluated in biopsies in an attempt to refine the recognition of DGF.


METHODS
Anti-cubulin and anti-AE-1/AE-3 antibodies identified proximal and distal tubules, respectively. The terminal deoxynucleotide transferase-mediated dUTP nick-end labeling technique and active caspase-3 staining were used to demonstrate apoptosis. Antibodies against superoxide dismutase (SOD) were used as markers of the protective tubular response. Tubular regeneration was evaluated using anti-ki 67 and antivimentin antibodies.


RESULTS
Of a total of 40 biopsies, 9 were associated with DGF. ATN was seen in 16 biopsies; 5 were associated with DGF. The finding of ATN in the biopsy of a graft predicted DGF in only 56% of cases. Absence of distal caspase-3 staining predicted the absence of ATN in 87% of cases. The presence of caspase-3 predicted ATN in 54% of cases. The detection of manganese-SOD in distal tubules predicts the absence of DGF in 76% of the cases.


CONCLUSIONS
The use of immunohistochemical staining on posttransplant renal biopsies improved its predictive value with respect to ATN and DGF: The absence of active caspase-3 in distal tubular epithelium predicts the absence of ATN in 87% of cases, whereas its presence predicts ATN in 54% of cases. The presence of manganese-SOD in distal tubules predicts the absence of DGF in 76% of cases.
Boom
Henk
H
Department of Nephrology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands. boomh@rdgg.nl
de Heer
Emile
E
van der Wal
Annemieke
A
Kruidenier
Laurens
L
de Fijter
Johan W
JW
Benediktsson
Hallgrimur
H
Paul
Leendert C
LC
van Es
Leendert A
LA
D001706:Biopsy; D053148:Caspase 3; D020169:Caspases / Q000378:metabolism; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000032:analysis; D016030:Kidney Transplantation; D007686:Kidney Tubules, Distal / Q000166:cytology / Q000201:enzymology* / Q000473:pathology / Q000637:transplantation*; D009336:Necrosis; D017382:Reactive Oxygen Species / Q000378:metabolism; D012189:Retrospective Studies; D013482:Superoxide Dismutase / Q000378:metabolism*; D013997:Time Factors; D014184:Transplantation, Homologous; D014746:Vimentin / Q000032:analysis
D019394:Ki-67 Antigen; D017382:Reactive Oxygen Species; D014746:Vimentin; D013482:Superoxide Dismutase; C505407:CASP3 protein, human; D053148:Caspase 3; D020169:Caspases