Journal Article

Infiltration of Macrophages Correlates with Severity of Allograft Rejection and Outcome in Human Kidney Transplantation

Kühne, Louisa, Banas, Miriam C., Banas, Bernhard, Bergler, Tobias, Wurm, Simone, Jung, Bettina, Rümmele, Petra, Bourier, Felix

2016

Overview

Despite substantial progress in recent years, graft survival beyond the first year still requires improvement. Since modern immunosuppression addresses mainly T-cell activation and proliferation, we studied macrophage infiltration into the allografts of 103 kidney transplant recipients during acute antibody and T-cell mediated rejection. Macrophage infiltration was correlated with both graft function and graft survival until month 36 after transplantation. Macrophage infiltration was significantly elevated in antibody-mediated and T-cell mediated rejection, but not in kidneys with established IFTA. Treatment of rejection with steroids was less successful in patients with more prominent macrophage infiltration into the allografts. Macrophage infiltration was accompanied by increased cell proliferation as well as antigen presentation. With regard to the compartmental distribution severity of T-cell-mediated rejection was correlated to the amount of CD68+ cells especially in the peritubular and perivascular compartment, whereas biopsies with ABMR showed mainly peritubular CD68 infiltration. Furthermore, severity of macrophage infiltration was a valid predictor of resulting creatinine values two weeks as well as two and three years after renal transplantation as illustrated by multivariate analysis. Additionally performed ROC curve analysis showed that magnitude of macrophage infiltration (below vs. above the median) was a valid predictor for the necessity to restart dialysis. Having additionally stratified biopsies in accordance to the magnitude of macrophage infiltration, differential CD68+ cell infiltration was reflected by striking differences in overall graft survival. The differences in acute allograft rejection have not only been reflected by different magnitudes of macrophage infiltration, but also by compartment-specific infiltration pattern and subsequent impact on resulting allograft function as well as need for dialysis initiation. There is a robust relationship between macrophage infiltration, accompanying antigen-presentation and resulting allograft function.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adolescent / Adult / Aged / Aged, 80 and over / Allografts / Analysis / Antigen presentation / Biology and Life Sciences / Cell activation / Cell Movement - immunology / Cell proliferation / Cell survival / Correlation / Creatinine / Dialysis / Female / Follow-Up Studies / Genetic aspects / Graft rejection / Graft Rejection - diagnosis / Graft Rejection - immunology / Graft vs Host Disease - diagnosis / Graft vs Host Disease - immunology / Grafting / Histology / Humans / Immunosuppression / Infiltration / Kidney Transplantation / Kidney transplants / Kidneys / Lymphocytes T / Macrophages / Macrophages - physiology / Male / Medicine and Health Sciences / Middle Aged / Multivariate analysis / Nephrology / Patients / Physiological aspects / Prognosis / Rejection / Risk factors / Severity of Illness Index / Steroid hormones / Steroids / Survival / Transplantation / Transplantation Immunology / Transplants & implants / Treatment Outcome / Young Adult