Abstract
Renal allograft biopsy is the gold standard procedure for diagnosis of kidney rejection via specific pathological changes. To provide a better assessment of immunologic events in acute T-cell-mediated rejection (acute TCMR) and BK virus-associated nephropathy (BKVAN) cases, we used multiplex immunofluorescence staining to identify infiltrating mononuclear cell subsets in the cortex area of transplanted kidneys. Antibodies to CD4, CD8, CD20, CD68, Foxp3, and cytokeratin were used. In cortical interstitium, CD8+ cells were significantly more prevalent in acute TCMR than BKVAN cases (34% vs. 22.8%, p = 0.034). In medulla, CD20+ cells were significantly more prevalent in BKVAN than acute TCMR cases (51.9% vs. 11.3%, p = 0.028).
Highlights
Renal allograft biopsy is the gold standard procedure for diagnosis of kidney rejection via specific pathological changes
T cells are known to be important in the pathogenesis of acute T-cell-mediated rejection (TCMR), multiple other mononuclear cell subpopulations, including B cells, NK cells, plasma cells, and monocytes/macrophages, have been shown to contribute to the outcome of rejection-related immunologic events [4,5,6,7]
The Regions of Interest (ROIs) were defined as follows (Figure 1): Medullary ray: The area with structures consisting of bundles of renal tubules which are formed in the renal cortex and continue to run through the renal medulla as medullary striations
Summary
Renal allograft biopsy is the gold standard procedure for diagnosis of kidney rejection via specific pathological changes. The major factor in acute T-cell-mediated rejection (TCMR) is tissue infiltration of mononuclear cells. T cells are known to be important in the pathogenesis of acute TCMR, multiple other mononuclear cell subpopulations, including B cells, NK cells, plasma cells, and monocytes/macrophages, have been shown to contribute to the outcome of rejection-related immunologic events [4,5,6,7]. To provide a better assessment of immunologic events in acute TCMR and BK virusassociated nephropathy (BKVAN) cases, we used multiplex immunofluorescence assays to identify infiltrating mononuclear cell subsets in a transplanted kidney in cortex areas. Because BKVAN has characteristic interstitial mononuclear cell infiltration, and even tubulitis, which is one of the symbolic changes of acute TCMR, it is difficult to differentiate between the two conditions. We tried to evaluate the differences in infiltrating cell subsets in the excluded areas for diagnosis, including fibrotic areas, the immediate subcapsular cortex, and adventitia around large vessels and medullary areas [1]
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