Molecular phenotypes of acute rejection predict kidney graft prognosis.
Earlier detection of antibody-mediated rejection of kidney allografts may improve graft outcomes. Profiling of gene expression holds promise for the diagnosis and prognosis of antibody-mediated rejection. Here, we identified 730 patients who received kidney transplants during 2002-2005, including 21 patients (2.9%) who experienced early acute antibody-mediated rejection. We also identified a matched group of 43 patients with early acute T cell-mediated rejection to serve as controls. Compared with patients with T cell-mediated rejection, those with antibody-mediated rejection had significantly higher intrarenal mRNA expression of the cytoprotective heme oxygenase-1 but had lower expression of the regulatory T cell marker forkhead box P3 (FoxP3), the B cell marker CD20, and the chemokine regulated upon activation, normal T cell expressed and secreted (RANTES). T cell infiltration was similar in both groups of patients. Compared with grafts that had a favorable course, those that failed as a result of antibody-mediated rejection had expression profiles suggesting a lack of regulation (less FoxP3, TGF-beta1, RANTES, and CD20). Grafts that failed as a result of T cell-mediated rejection only revealed lower expression of CD20 mRNA. In summary, these data suggest that severe antibody-mediated rejection and T cell-mediated rejection result in graft loss by distinct mechanisms. Molecular phenotypes of early acute rejection might help to identify grafts with poor prognosis, allowing earlier application of additional therapies.
Viklicky
Ondrej
O
Department of Nephrology, Transplant Center, Institute for Clinical and Experimental Medicine, Videnska 1958, 14021 Prague, Czech Republic. ondrej.viklicky@medicon.cz
Hribova
Petra
P
Volk
Hans-Dieter
HD
Slatinska
Janka
J
Petrasek
Jan
J
Bandur
Stepan
S
Honsova
Eva
E
Reinke
Petra
P
D000328:Adult; D000906:Antibodies / Q000276:immunology; D018951:Antigens, CD20 / Q000235:genetics / Q000378:metabolism; D016022:Case-Control Studies; D018946:Chemokine CCL5 / Q000235:genetics / Q000378:metabolism; D005260:Female; D051858:Forkhead Transcription Factors / Q000235:genetics / Q000378:metabolism; D020869:Gene Expression Profiling; D006084:Graft Rejection / Q000235:genetics* / Q000276:immunology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000276:immunology* / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013601:T-Lymphocytes / Q000276:immunology; D053773:Transforming Growth Factor beta1 / Q000235:genetics / Q000378:metabolism
D000906:Antibodies; D018951:Antigens, CD20; D018946:Chemokine CCL5; C418974:FOXP3 protein, human; D051858:Forkhead Transcription Factors; D053773:Transforming Growth Factor beta1