J Korean Soc Transplant.  1998 Jun;12(1):49-58.

Microchimerism in Living Related Renal Transplants

Affiliations
  • 1Department of Surgery, Seoul National University College of Medicine, Korea.
  • 2Department of Clinical Pathology, Seoul National University College of Medicine, Korea.
  • 3Department of Internal Medicine, Seoul National University College of Medicine, Korea.

Abstract

BACKGROUND: Immune tolerance is regarded as the goal of the organ transplantation (TPLx), but the mechanism of tolerance induction remains to be established. Microchimerism (MC) development in long-surviving recipients after solid organ TPLx might be linked to tolerance.
OBJECTIVE
We investigated the development and clinical relevance of donor specific MC in living related renal transplants with good graft function more than 3 years after TPLx. The relationship between MC and mixed lymphocyte reaction (MLR) hyporeactivity was also evaluated.
MATERIALS AND METHODS
Eighteen recipients were included in this study among recipients whose renal function were stable for more than 3 years and have at least one mismatch of HLA DR loci. Donor-specific MC was examined with nested PCR method using HLA DRB1 gene probe in DNA extracted from peripheral blood and forearm skin tissue samples. Mean age at TPLx was 28.9 yrs (range: 13~42 yrs) and mean follow-up period was 67.4 months (range: 36~173 mos). Male to female ratio was 11:7. Acute rejection occurred in 4 and were reversed with steroid pulse therapy. All donors were alive (parent:8, sibling:9, offspring:1). Immunosuppression regimens were CSA(+)PDS in 11, AZA PDS in 1, AZA CSA(+)PDS in 5, and CSA monotherapy in 1. Mean serum BUN/Cr at the point of this study were 22.2+/-6.7 / 1.54+/-0.81 (mg/dL). The sensitivity of nested PCR using HLA DRB1 probe was 1/105~1/106.
RESULTS
Donor-specific MC was detected in 6 (33.3%) (5 in blood, 5 in skin tissue). Nested PCR method was more sensitive than single round SSP-PCR method which showed only 2 positive recipients (11.1%). Two of four acute rejection experienced recipients were MC positive. Recipients were divided into two groups according to the follow-up period of 5 years. Two groups showed equal number of MC positivity. MLR was decreased in a group of more than 5 yrs follow-up. However, there was no difference in the decrement of MLR between MC positive and negative groups.
CONCLUSION
MC was detected in 33.3% patients with nested PCR method. Since the MC positivity and MLR hyporesponsiveness shows no relationship, the significance of MC relevant to tolerance is to be determined through further study.

Keyword

Microchimerism; Tolerance; Renal transplantation; MLR; Nested PCR

MeSH Terms

Chimerism*
DNA
Female
Follow-Up Studies
Forearm
HLA-DRB1 Chains
Humans
Immune Tolerance
Immunosuppression
Kidney Transplantation
Lymphocyte Culture Test, Mixed
Male
Organ Transplantation
Polymerase Chain Reaction
Skin
Tissue Donors
Transplants
DNA
HLA-DRB1 Chains
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