Apoptosis of tubular epithelial cells in donor kidney biopsies predicts early renal allograft function

Acute renal failure (ARF) is a serious complication in the early postoperat ive period after kidney transplantation. In an effort to identify subjects at risk, several donor-, recipient-, and procedure-related factors have bee n studied. Because no morphologic parameter predictive of delayed graft fun ction has been identified to date, this study was conducted to determine wh ether the number of apoptotic cells in donor biopsies obtained before engra ftment is predictive of the development of posttransplant ARF. Donor biopsi es of patients with "biopsy-proven" acute tubular damage but no signs of re jection (n = 23) showed significantly higher counts of apoptotic tubular ep ithelial cells when compared to patients with immediate transplant function (n = 44) or early rejection (n = 22). Ih all groups, a significantly highe r percentage of apoptotic cells was found in the distal compared to the pro ximal tubule. The expression of bcl-2 and proliferating cell nuclear antige n was not different among the groups. Late allograft function was not affec ted by early ARF as serum creatinine values were similar in all three group s after 6 mo. These data suggest that the number of apoptotic renal tubular epithelial cells in donor biopsies before engraftment is predictive of the early postoperative course in patients undergoing kidney transplantation.