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Background: Ability to predict the manner in which a recipient’s immune system would respond to a transplanted graft by analyzing cytokine profiles of the “allograft antigen sensitized” recipient lymphocytes in vitro might provide a means to identify patients at risk to adverse clinical endpoints.Methods: Cytokine/chemokine gene expression profiles of peripheral blood mononuclear cells co-cultured with allograft antigen-pulsed macrophages were studied in 49 renal transplant recipients—12 with acute cellular rejection (ACR) with or without antibody-mediated rejection (AMR), 7 with AMR (without ACR), and 30 with stable allografts (SA). An 86-gene inflammatory cytokines and receptors PCR array was used to measure fold changes in gene expression between pulsed and un-pulsed cultures.Results: On linear discriminant analysis and multivariate analysis of variance, a gene set comprising C3, CCL3, IL1B, TOLLIP, IL10, CXCL5, ABCF1, CCR3, IL10RB, CXCL1, and IL1R1 differentiated the ACR-AMR from the SA group. Similarly, a gene set comprising IL10, C3, IL37, IL1B, CCL3, CARD18, and TOLLIP differentiated the AMR from the SA group. No significant difference was found between the ACR-AMR vs AMR groups.Conclusion: Distinct post in vitro stimulation cytokine profiles at the time of transplantation thus correlated with the occurrence of post-transplantation rejection episodes which indicated feasibility of this in vitro model to assess the recipient’s anti-graft response at an early stage. [ABSTRACT FROM AUTHOR]

Repair of vascular defects in the presence of infection remains a challenging task in immunocompromised patients. We report two patients with postrenal transplant Aspergillus mycotic aneurysms of the allograft renal artery involving the external iliac artery which were excised along with the allograft. The defect in the external iliac artery was repaired successfully with interposition of autogenous internal iliac artery graft. Use of an internal iliac artery graft in such settings has been rarely reported in English literature. Autogenous internal iliac artery grafts provide a useful method to bridge the vascular defects created by radical debridement in the presence of fungal infections. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor on early allograft failure in an unrecognized case of primary hyperoxalosis.

Identification of pathological events in the renal allograft using protocol biopsies at predetermined time intervals may yield useful information and improve outcomes. We examined the influence of decisions taken on the basis of 1 and 3-month protocol biopsies findings on 1-year renal allograft function in a prospective randomized study. Out of 102 living-donor allograft recipients, 52 were randomized to undergo protocol biopsies and 50 controls had only indicated biopsies. All acute rejection episodes (clinical and subclinical) were treated. CNI dose adjustments were made on clinical judgement. Baseline recipient and donor characteristics, immunosuppressive drug usage, HLA matches, and 2-hour cyclosporine levels were similar in both groups. At 1 and 3 months, protocol biopsies revealed borderline changes in 11.5% and 14% patients, acute rejection in 17.3% and 12%, and chronic allograft nephropathy in 3.8% and 10%. The incidence of clinically evident acute rejection episodes was similar in the two groups, but biopsy group had lower serum creatinine at 6-months (P=0.0003) and 1-year (P< 0.0001). The creatinine values were similar in those with normal histology and borderline changes. Protocol biopsies are helpful in detecting subclinical histological changes in the graft; and management decisions based on this information improve short-term renal allograft function. [ABSTRACT FROM AUTHOR]

Comments on Claudio Ponticelli and Margarita Villa's article about the evaluation of risk factors for late kidney allograft failure. Association between body mass index and risk of graft failure; Effect of nephron dosing on late allograft failure.