DONOR PLATELET AND LEUKOCYTE LOAD IDENTIFY RENAL ALLOGRAFTS AT AN INCREASED RISK OF ACUTE REJECTION1

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Abstract
A reduction in acute rejection may reduce graft losses from chronic rejection, benefiting the recipient and helping ease the huge donor organ shortfall in the UK. The prediction of recipients at greater risk of acute rejection might justify the administration to them of more potent immunosuppression, but defining this group on clinical parameters has been largely unsuccessful. Events impacting on the kidney by the time of donation may, if detectable histologically, predict those kidneys more likely to undergo rejection. A prospective immunohistochemical analysis was undertaken to detect P-Selectin (PS), E-Selectin (ES), platelets, leukocyte common antigen, macrophages, T cells, and neutrophils in the pretransplant biopsies of 77 adult renal transplant recipients. Twenty-nine (38%) of this group rejected. A significantly increased number of recipients rejected if the donor biopsy was PS positive (63 vs. 24%, P =0.0007), contained five or more leukocytes/glomerulus (48 vs. 21%, P =0.03), contained >9.3 leukocytes/high power field (46.5 vs. 10.5%, P =0.006) or was both PS positive and contained >9.3 leukocytes/high power field (61.9 vs. 0.0%, P =0.0001). The PS was mostly of platelet origin and the majority of leukocytes were macrophages. Only previous CMV or any current infection in the donor correlated with the immunohistochemical changes. These immuno-histochemical changes are present before transplantation, which allows the prediction of recipients at both a higher and a lower risk of acute rejection, enabling the administration of recipient tailored immunosuppression, and supports the use of additional therapeutic intervention to reduce the injury response both within the recipient and the donor.