USEFULNESS OF HLA-DR EXPRESSION IN TUBULA R CELLS FOR THE DIAGNOSIS OF REJECTION IN KIDNEY-TRANSPLANTATION

BACKGROUND: Fine needle aspiration is a useful technique as a monitori zation method after kidney transplantation for diagnosis of rejection. In addition to the cells of the intrarenal inflammatory infiltrate, t he material obtained contains an important quantity of parenchymatous renal cells. The expression of class II HLA antigens in renal tubular cells has been related with episodes of rejection. The aim of this stu dy was to determine the clinical usefulness of fine needle aspiration in diagnosis and control of kidney transplant rejection.PATIENTS AND M ETHODS: HLA-DR expression of renal tubular cells obtained in 155 fine needle aspirations carried out in 36 consecutive kidney transplantatio ns were prospectively studied. The technique used was that of alkaline phosphatase, The study period included the two months following the g raft. RESULTS: Rejection was considered to occur on expression of HLA- DR in more than 20% of tubular cells and as thus this method showed a sensitivity and specificity of 78 and 89%, respectively. Likewise, a g ood correlation was observed between the persistence of tubular HLA-DR expression following rejection treatment and severity of the same. Th e group of patients with stable renal function presented a slight, tra nsitory expression within the first 10-12 days after transplantation. CONCLUSIONS: HLA-DR expression of the tubular cells obtained by aspira tion puncture is a useful method for the diagnosis and control of kidn ey transplant rejection.