J Korean Soc Transplant.  2001 Dec;15(2):151-157.

Predictive Value of an Immunohistochemical Staining for HLA-DR, ICAM-1 and VCAM-1 in Acute Renal Allograft Rejection

• Kim WS
• Lee WM
• Park CH
• Kang CM
• Kwak JY
• Park MH

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 mg/dl to 1.5 mg/dl 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

Kidney transplantation; Rejection; HLA-DR; ICAM-1; VCAM-1

MeSH Terms

Allografts*
Biopsy
Classification
Creatinine
Cyclosporine
Diagnosis
Glomerulonephritis, IGA
Glomerulosclerosis, Focal Segmental
Graft Rejection
HLA-DR Antigens*
Humans
Intercellular Adhesion Molecule-1*
Kidney Transplantation
Necrosis
Pathology
Transplants
Vascular Cell Adhesion Molecule-1*
Creatinine
Cyclosporine
HLA-DR Antigens
Intercellular Adhesion Molecule-1
Vascular Cell Adhesion Molecule-1