Potential predictive markers in protocol biopsies for premature renal graft loss.
OBJECTIVE
Protocol biopsies offer new possibilities to predict kidney allograft outcome. The aim of this study was to find clinical, laboratory, morphological and molecular predictors of short-term renal graft survival.


METHODS
Three-month protocol kidney graft biopsy was carried out on 257 patients. The real-time RT-PCR was used to identify intragraft mRNA expression of several cytokines and chemokines and predictive statistics was performed to find markers connected with the risk of premature graft failure.


RESULTS
Compared to patients with normal morphology at 3 months, patients with subclinical rejection including borderline changes had experienced more frequent (p < 0.001) acute rejections before 3-month biopsy, serum creatinine >or=170 micromol/l (p < 0.01), and higher intrarenal expression of RANTES, IP-10 (p < 0.001), C3, CD3, IgJ (p < 0.01) and CD20 (p < 0.05). There was a significant correlation between subclinical rejection and the occurrence of late acute rejection and graft failure at the first year after transplantation. Moreover, higher RANTES and IP-10 expressions in subclinical rejection predicted graft loss at one year after transplantation in the univariate analysis.


CONCLUSIONS
Patients with subclinical rejection including borderline changes in 3-month biopsy and particularly those with higher intrarenal expression of RANTES and IP-10 mRNA were found to be at risk for premature kidney graft loss.
Matl
Ivo
I
Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. ivo.matl@ikem.cz
Hribova
Petra
P
Honsova
Eva
E
Brabcova
Irena
I
Viklicky
Ondrej
O
D000328:Adult; D018951:Antigens, CD20 / Q000235:genetics; D015415:Biomarkers; D001706:Biopsy; D017252:CD3 Complex / Q000235:genetics; D018946:Chemokine CCL5 / Q000235:genetics*; D054357:Chemokine CXCL10 / Q000235:genetics*; D003176:Complement C3 / Q000235:genetics; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012333:RNA, Messenger / Q000378:metabolism; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012307:Risk Factors
D018951:Antigens, CD20; D015415:Biomarkers; D017252:CD3 Complex; C114753:CXCL10 protein, human; D018946:Chemokine CCL5; D054357:Chemokine CXCL10; D003176:Complement C3; D007166:Immunosuppressive Agents; D012333:RNA, Messenger; D003404:Creatinine