MACROPHAGES AND HLA-DR(-TRANSPLANTS, PREDICT SUBSEQUENT GRAFT-SURVIVAL, EVEN AFTER REVERSAL OF THE ACUTE EPISODE() CELLS IN ACUTELY REJECTING KIDNEY)

Renal graft biopsies from 19 selected patients with acute cellular rej ection (ACR) were analysed using a panel of monoclonal antibodies. All patients had only one episode of ACR, which was completely reversible . In 11 patients (group 1) graft function slowly deteriorated over a p eriod of 14 (+/-17) months after the episode. In the remaining eight ( group 2) graft function remained stable over a similar period of obser vation. In group 1 there was a significantly increased infiltrate of g lomerular and interstitial monocytes/ macrophages (MM) when compared w ith group 2. Also, the expression of HLA-DR antigen by the tubular cel ls were stronger in group 1, while T-cells in the glomeruli and the in terstitium were equally distributed in both groups. We conclude that l arge numbers of MM and HLA-DR expressing cells (glomerular, interstiti al and tubular) in rejecting kidneys predict a more rapid decline of f ollow-up renal function despite reversal of the acute episode. This ma y suggest that subclinical ongoing injury continues in some patients a nd perhaps more intense immunosuppression is necessary to prevent graf t loss.