|
KMID : 0361120010150020151
|
|
Korean Journal of Transplantation
2001 Volume.15 No. 2 p.151 ~ p.157
|
|
|
Predictive Value of an Immunohistochemical Staining for HLA-DR, ICAM-1 and VCAM-1 in Acute Renal Allograft Rejection
|
|
김완섭‡/Wan Seop Kim‡
이원미/박찬현*/강종명*/곽진영†/박문향/Won Mi Lee/Chan Hyun Park*/Chong Myung Kang*/Jin Young Kwak†/Moon Hyang Park
|
|
|
Abstract
|
|
|
Purpose: We have evaluated the diagnostic and predictive value of HLA-DR, ICAM-1 and VCAM-1 expression in patients clinically suspected with acute rejection. Methods: Immunohistochemical staining for HLA-DR, ICAM-1 and VCAM-1 was
performed
in 21 patients who had graft dysfunction. According to the Banff 97 working classification of renal allograft pathology, eight cases were classified as acute rejection (one borderline changes, two Type ⅠA, two Type ⅠB, one Type ⅡA, two Type
ⅡB). The
other cause of renal dysfunction included mild acute tubular necrosis (n=4), recurrent focal segmental glomerulosclerosis (n=3), recurrent IgA nephropathy with or without chronic transplant nephropathy (n=3), chronic allograft nephropathy (n=2),
allograft glomerulopathy (n=1). Among these, three patients showed mild acute cyclosporin toxicity. Results: Expression of HLA-DR more than 25% of tubular cells was noted in 8 cases out of 12 patients with clinically improved serum
creatinine
levels. These 8 cases were pathologically diagnosed as borderline in 1 case, acute rejection Type ⅠA in 2, Type ⅠB in 2, Type ⅡA in 1 case and Type ⅡB in 2 cases. In one patient showing pathologically 'borderline changes' and high HLA-DR
expression
(90% of tubular cells), serum creatinine level was remarkably improved from 5.5 ㎎/㎗ to 1.5 ㎎/㎗ after treating for acute rejection. Nine cases with no or low expression of HLA-DR (weak staining in less than 10% of tubular cells) include 3
biopsies of
recurrent FSGS, 3 recurrent IgA nephropathy, 1 allograft glomerulopathy, 3 acute cyclosporin toxicity, and 3 acute tubular necrosis. Conclusion: Our data show that increased tubular expression of HLA-DR, ICAM-1 and VCAM-1 is significantly
related
to acute graft rejection. Immunohistochemical staining for HLA- DR is more useful than ICAM-1 and VCAM-1 in the diagnosis of renal allograft rejection.
|
|
|
KEYWORD
|
|
|
|
|
|
FullTexts / Linksout information
|
|
|
|
|
|
Listed journal information
|
|
  
|
|