Urinary HLA-DR and CD54 expression--indicators for inflammatory activity in decoy cell shedding patients.
BACKGROUND
Polyomavirus (PV) nephropathy may coexist with or follow acute renal transplant rejection. The aim of this study was to evaluate whether HLA-DR and CD54 are useful cellular markers for surveillance of acute rejection in PV-infected patients.


METHODS
A prospective study was conducted using 205 renal transplant patients. Urine samples were collected at a regular interval post-transplantation for routine cytology and immunocytochemistry. Urinary levels of tumour necrosis factor alpha, soluble interleukin-2 receptor and interleukin-6 were used as adjunctive markers for acute rejection.


RESULTS
Of the 699 total samples, decoy cells were identified in 100 samples of 50 patients. Patients with decoy cell-positive (DCP) samples had higher serum creatinine levels than decoy cell-negative (DCN) samples (1.55 vs 1.41 mg/dl, respectively; P = 0.006). DCP samples were also more likely to be HLA-DR positive (50.0 vs 32.4%; P = 0.029), as well as CD54 positive (17.4 vs 6.9%; P = 0.038). However, serum creatinine levels did not correlate with HLA-DR or CD54 positivity among DCP samples. Instead, CD54 positivity correlated with decoy cell grades. Immunosuppression decreased in 11 DCP patients, and HLA-DR was negatively converted in three of them. None of the patients developed acute clinical rejection. Urinary cytokine levels did not correlate with serum creatinine levels, nor did they correlate with HLA-DR or CD54 status among DCP patients.


CONCLUSIONS
Urinary tubular HLA-DR and CD54 expression increased in decoy cell shedding patients but did not indicate a concomitant acute rejection. These markers may instead indicate renal inflammatory activity associated with viral reactivation, which has the potential to progress to PV interstitial nephritis.
Kim
Se Hoon
SH
Department of Pathology, Institute of Renal Disease, Yonsei University College of Medicine, Seoul 120-752, Korea .
Ahn
Hyung Joon
HJ
Kim
Yu Seun
YS
Kim
Soon Il
SI
Kim
Hyun Sook
HS
Jeong
Hyeon Joo
HJ
D000208:Acute Disease; D015415:Biomarkers / Q000652:urine; D001706:Biopsy; D002452:Cell Count; D016207:Cytokines / Q000652:urine; D004797:Enzyme-Linked Immunosorbent Assay; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology / Q000473:pathology / Q000652:urine*; D006684:HLA-DR Antigens / Q000652:urine*; D006801:Humans; D007150:Immunohistochemistry; D018799:Intercellular Adhesion Molecule-1 / Q000652:urine*; D016030:Kidney Transplantation / Q000276:immunology* / Q000473:pathology; D007684:Kidney Tubules / Q000473:pathology*; D027601:Polyomavirus Infections / Q000150:complications / Q000473:pathology / Q000652:urine; D011379:Prognosis; D011446:Prospective Studies
D015415:Biomarkers; D016207:Cytokines; D006684:HLA-DR Antigens; D018799:Intercellular Adhesion Molecule-1