MACROPHAGES AND CHRONIC RENAL-ALLOGRAFT NEPHROPATHY

In a previous study we demonstrated that macrophage infiltrates staine d for thromboxane A synthase (TxAS) correlated inversely with renal fu nction six months after biopsy. We propose that macrophage based infla mmation is a cofactor leading to chronic allograft nephropathy. For th is study we compared four indices of renal allograft nephropathy with renal survival. The Banff Score of Inflammatory Changes (BSI) is an in dex of acute inflammation. The Banff Chronic Index (BCI) and Chronic A llograft Damage Index (CADI) are indexes of chronic disease. The Macro phage Index (MI) is the same as the BSI applied only to macrophages. T hese indices were determined on renal allograft biopsies obtained beca use of delayed graft function within the first week of transplantation , and for increasing plasma creatinine levels after stable function. A ll four indices predicted renal survival in the post-biopsy interval. MI predicted renal survival for the entire transplant period. In addit ion, the presence of TxAS transcripts in the renal allografts was dete rmined using a reverse transcription-polymerase chain reaction-based a ssay. This confirms previous observations of TxAS in the grafts. This study supports the hypothesis that macrophage derived inflammation is a cofactor for chronic allograft nephropathy.