title: On the intraoperative molecular status of renal allografts after vascular reperfusion and clinical outcomes.
abstract: Many hypothesize that subtle inflammation and immune activity detected in the intraoperative period are linked to adverse postkidney transplant clinical outcomes. To this end, renal allografts were analyzed for expression of pro-inflammatory, inflammation-induced adhesion molecules, immune activation as well as anti-apoptotic genes expressed 15 min after vascular reperfusion (zero-hour) to determine whether this analysis can aid in predicting the occurrence of delayed graft function (DGF), acute rejection (AR), and the quality of graft function at 6 mo. Intraoperative biopsies were obtained from 75 consecutively performed renal allografts in which consent was obtained 15 min after vascular reperfusion. These biopsies were analyzed by quantitative real-time PCR for transcription of 15 select genes and by standard histopathology. Posttransplant clinical outcomes were also analyzed in respect to intraoperative transcriptional profiles and clinical parameters available at the time of transplantation. This study demonstrates that a limited and hypothesis-driven PCR-based transcriptional profile of the zero-hour kidney biopsy predicts posttransplant clinical outcomes including DGF, early AR, and the quality of renal function 6 mo posttransplantation. For some clinical endpoints, the combined use of molecular analysis and established clinical indicators available at the time of transplantation further enhances the quality of prognosis. The transcriptional profiling data provide absolutely essential data to the predictive models, particularly with respect to AR and renal function 6 mo posttransplantation.
authors.affiliation: Department of Medicine Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA, USA.
authors.forename: Yingyos
authors.initials: Y
authors.lastname: Avihingsanon
authors.forename: Naili
authors.initials: N
authors.lastname: Ma
authors.forename: Martha
authors.initials: M
authors.lastname: Pavlakis
authors.forename: W James
authors.initials: WJ
authors.lastname: Chon
authors.forename: Marc E
authors.initials: ME
authors.lastname: Uknis
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Monaco
authors.forename: Christiane
authors.initials: C
authors.lastname: Ferran
authors.forename: Isaac
authors.initials: I
authors.lastname: Stillman
authors.forename: Asher D
authors.initials: AD
authors.lastname: Schachter
authors.forename: Christina
authors.initials: C
authors.lastname: Mottley
authors.forename: Xin Xiao
authors.initials: XX
authors.lastname: Zheng
authors.forename: Terry B
authors.initials: TB
authors.lastname: Strom
mesh_terms: D015415:Biomarkers; D006084:Graft Rejection / Q000235:genetics / Q000276:immunology; D006085:Graft Survival / Q000235:genetics* / Q000276:immunology*; D006801:Humans; D007432:Intraoperative Period; D007511:Ischemia / Q000235:genetics* / Q000276:immunology; D007668:Kidney / Q000098:blood supply / Q000276:immunology*; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation / Q000276:immunology; D011237:Predictive Value of Tests; D015424:Reperfusion; D014184:Transplantation, Homologous / Q000276:immunology*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers