Diagnosis of Renal Allograft Rejection by Analysis of Fine-Needle Aspiration Biopsy Specimens With Im-munostains and Simple Cytology

This rev1evv of the rnanagement of acute renal failure in children is recommended io anyone irtvolved with the care of such children. Because in essence it is a summary the article does not lend itself to further summarization and should be read in its G. W. K 34 references 2

TRANSPLANTATION T Lymphocyte Cloning From Rejected Human Kidney Alfografts. Growth Frequency and Fi.mctio:nal/Phenotypic Analysis J. F.

Y.

MOREAU, M. BONNEVILLE, M. A. PEYRAT, A. GODARD, JACQUES, C. DESGRANGES AND J.P. Souuuou, Institut

National de la Sante et de la Recherche Medicale Unite, Faculte de Medecine, Nantes, Centre d'Epidemiologie et d'Immunovirologie, Faculte de Medecine Alexis Carrel, Lyon and Centre Hospitalier Regional de Nantes, Nantes, France J. Clin. Invest., 78: 874-879

1986

The rejection phenomenon has been characterized previously by studies of activated T- lymphocytes, including monoclonal antibodies directed specifically against surface membrane antigens. With a limiting dilution the authors were able to obtain 55 clones Growth 1rEiQU16IlCV 1mnn,v,,r1 5.c;;,,a,.,.-auc.,y using kidney donor -,y,u,nnA,y immortalized Epstein-Barr virus infection. The virus clones were characterized for cytotoxicity, antigen-driven proliferation, cell surface phenotype and interleukin-2 µn,uu ...,c,·vu. Although 90 per cent of the lymphocytes did not grow in this experimental system, the technique is considered to be useful for fine needle aspiration biopsies of kidneys believed to be undergoing rejection.

J.D. S. 4, figures, 3 tables, 27 references

Renal Transplantation: An Analyg:is of "-'''s§''""'"'n' and Medical Faetrnrs Affecth1g Cad.acveir Organ Availability YtPH.s!Iln.

and Ohio

Cleveland Clin,

1986

The National ·,,_"n,_.,_·n,,,"-',,''-'was enacted in 1984 to support the continued ~•up,,,u,.," of a sive procurement and distribution network in the United States for w.c.uv··-·· organs and tissues, as well as a for potential ""'',,.''"'n" Demand for the kidney has increased dramatically for a number of desirable reasons: more patients have been accepted for transplantation, age limits for transplantation have been extended, results have improved and there are more transplantation centers doing more transplants. Undesirable factors also have increased the demand. There has been no major breakthrough in treatment of the renal diseases that most frequently progress to end stage failure and graft rejection continues to be a problem. On the other hand, the supply of cadaver kidneys has decreased. Fortunately, the number of fatal motor vehicle accidents has decreased because of the lowered highway speed limit and seat belt use. However, unfortunately, public misconceptions about transplants, law-

3uits and gaps in 1-'"·'"'"'"'"J'v,.,m ""'uH2rn,.; also have decreased the supply. Although rejection can be treated with immunosuppression after transplantation, 1st,oc<)mpat1b,1l1i;y matching of donor and rei:1p1er1t before transplantation has increased graft survival '"E,'H'""'"'" The national initiative may provide the critical mass necessary to correct some of the misconceptions and lingering problems that fmstrate the optimal use and success of human organ transplants. G. P. lvl. 31 references

Cyclosporin iIDl Therapeutic Dose§ Increases Renal Allograft V ascu.far Re§istance J. J. CURTIS, R. G. LUKE, E. DUBOVSKY, A. G. DmTHELM, J. D. WHELCHEL AND P. JONES, Departments of Medicine and Surgery, and the Nephrology Research and Training Center, University of Alabama Medical Center, Birmingham, Alabama Lancet, 2: 477-479 (Aug. 20) 1986 Renal impairment with cyclosporin is rapidly reversible when the treatment stops (even after lengthy exposure to cyclosporin). The degree of renal impairment reaches equilibrium if the drug dose is kept constant. In a prospective study of 14 renal transplant patients converted from cyclosporin to azathioprine therapy for financial reasons renal blood flow was greater and renal vascular resistance was lower after conversion. These changes occmred without any change in semm creatinine levels. This finding suggests that the renal allograft vasoconstriction induced cyclosporin occurs before evidence of nephrotoxicity and that the vasoconstriction is reversibleo Renal allograft recipients had cydosporin-induced hemodynamic changes even early (2 weeks) after transplantation, when the allograft still is denervated. These findings may explain the increased sensitivity to other nephrotoxic agents and hypertension observed in cyclosporin-treated patients. P. R. R. 2 tables, 25 references

Diagnrn,i!'l of Renal A.llogJt aft Rejection A.u.alysis of Fine-Needle A!lpirratfon Biopsy Specimens With Im.mmuDstains and Simple Cytology 0

Go A.

BISHOP, B. M. HALL, J. HORVATH, G. G. DUGGIN, SHEIL AND D. J,

J. R.

Prince Lancet, 2: 645-650

1986

Of 155 fine needle a"Jf'Has,.vu specimens obtained from 37 ..,u,,.~,.,vo during the initial hospital stay l to 8 weeks after 109 aspirates were analyzed: 70 were from 24 patients treated with cydosporin, and 39 were from 11 patients treated with azathioprine and prednisone. Commercially available monoclonal antibodies and an immunoperoxidase stain were used to analyze these specimens. Three cellular features associated with acute cellular rejection were identified: heavy infiltrates of activated T cells, large mononuclear cells strongly expressing HLA-DR antigens and HLA-DR expression by renal tubular cells. A combination of semiquantitative scores for these features correctly identified rejection in 32 of 34 cases, with no false positive results in cases of cyclosporin nephrotoxicity or stable graft function. P. R. R. 3 figures, 3 tables, 32 references