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Macrophages and HLA-DR(+) cells in acutely rejecting kidney transplants, predict subsequent graft survival, even after reversal of the acute episode

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Renal graft biopsies from 19 selected patients with acute cellular rejection (ACR) were analysed using a panel of monoclonal antibodies. All patients had only one episode of ACR, which was completely reversible. In 11 patients (group 1) graft function slowly deteriorated over a period of 14 (±17) months after the episode. In the remaining eight (group 2) graft function remained stable over a similar period of observation. In group 1 there was a significantly increased inflitrate of glomerular and interstitial monocytes/macrophages (MM) when compared with group 2. Also, the expression of HLA-DR antigen by the tubular cells were stronger in group 1, while T-cells in the glomeruli and the interstitium were equally distributed in both groups. We conclude that large numbers of MM and HLA-DR expressing cells (glomerular, interstitial and tubular) in rejecting kidneys predict a more rapid decline of follow-up renal function despite reversal of the acute episode. This may suggest that subclinical ongoing injury continues in some patients and perhaps more intense immunosuppression is necessary to prevent graft loss.
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Keywords: HLA-DR expression; acute rejection; monocytes/macrophages; outcome; renal graft

Document Type: Research Article

Affiliations: , Hippokration General Hospital, Thessaloniki, Greece

Publication date: 1998-01-01

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