Significance of Early Biopsy in Pediatric Kidney Transplantation

T. Ishimura; T. Ishida; M. Fujisawa

doi:10.1055/s-2003-41603

Aktuelle Urologie, Table of Contents

Aktuelle Urol 2003; 34(4): 234-238
DOI: 10.1055/s-2003-41603

Original Article

Significance of Early Biopsy in Pediatric Kidney Transplantation

Bedeutung der Frühbiopsie bei einer kindlichen NierentransplantationT. Ishimura¹ , T. Ishida² , M. Fujisawa¹

¹Department of Urology, Kawasaki Medical School, Kurashiki, Japan
²Division of Urology, Department of Organs Therapeutics, Kobe University Graduate School of Medicine, Kobe, Japan

Abstract

Long-term renal allograft survival is limited mainly by the progressive process termed chronic allograft nephropathy (CAN) or chronic rejection. A pathological feature of CAN is characterized by progressive interstitial fibrosis. Transforming growth factor (TGF)-β₁ plays an important role in fibrogenesis. We investigated whether the degree of TGF-β₁ expression in early biopsy specimens routinely obtained from stable allografts at 100 days could predict fibrosis and graft dysfunction in the late phase by immunohistochemistry. Patients were children with a graft from related donors. We immunohistochemically determined intracellular and extracellular expression of TGF-β₁ in the graft at 100 days using LC antibody (LC) for intracellular TGF-β₁ and CC antibody (CC) for extracellular TGF-β₁. We used the change in creatinine clearance between 100 days and 3 years after transplantation (ΔCcr) as an index of long-term graft function. Image analysis was used to calculate the relative area involved by interstitial fibrosis in trichrome-stained sections of graft biopsy specimens at 100 days and 3 years, designating the change as ΔFI. ΔCcr was - 4.2 ± 9.4 mL/min in subjects with minimal early immunoreactivity for CC and - 20.5 ± 5.9 mL/min in subjects with strong reactivity (p < 0.05). ΔCcr was - 14.5 ± 18.6 mL/min in subjects with minimal early immunoreactivity for LC and - 11.7 ± 12.8 mL/min in those with strong reactivity. ΔFI in subjects with minimal CC reactivity (1.28 ± 4.11 %) tended to be lower than in subjects with strong reactivity (8.45 ± 15.47 %). Neither fibrosis at 100 days nor ΔFI differed between subjects with minimal and strong LC reactivity. Thus, extracellular TGF-β₁ expression in grafts at 100 days after transplantation has an influence on long-term graft function and tends to be associated with increased graft fibrosis at 3 years.

Key words

Chronic allograft nephropathy - renal function - fibrosis - kidney transplantation

Full Text

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Masato Fujisawa

Department of Urology, · Kawasaki Medical School

577 Matsushima, Kurashiki, 701-0192, Japan

Phone: +81-86-462-1111

Fax: +81-86-462-1199

Email: masato@med.kawasaki-m.ac.jp