Cadaver versus living donor kidneys: Impact of donor factors on antigen induction before transplantation

Background. It is widely recognized that living-related donor (LRD) renal a llografts have a higher overall graft survival than cadaver donor transplan ts. We tested the hypothesis that part of this is attributable to LRD kidne ys being obtained under optimal conditions from healthy donors, whereas cad averic kidneys may have experienced injury as a result of inflammatory even ts around the time of brain death. Methods. We have performed a comparative immunohistochemical analysis of pr etransplant donor biopsies from cadaveric (N = 65) and LRD (N = 29) kidneys to determine any differences that may predispose them to subsequent damage . Cryostat sections were stained with antibodies to leukocytes, adhesion mo lecules, and human leukocyte antigen (HLA)-DR antigens, and the expression was assessed semiquantitatively. Results. High levels of endothelial E-selectin and proximal tubular express ion of HLA-DR antigens, intercellular adhesion molecule-1, and vascular cel l adhesion molecule-1 were detected in biopsies from cadaveric kidneys, whe reas expression of these markers was markedly reduced in LRD kidneys. High levels of tubular antigen expression were significantly associated with tra umatic death, prolonged ventilation, and episodes of infection in cadaver d onors. Furthermore, the expression of pretransplant tubular antigens in cad aver donor kidneys was significantly associated with early acute rejection following transplantation, suggesting that such kidneys are predisposed to subsequent immune-mediated attack following transplantation. Conclusions. These results may explain, in part, the superior outcome of LR D allografts compared with cadaver renal allografts.