Figure 98

Fine-needle aspiration cytology technique for the transplanted kidney. A 23- or 25-gauge spinal needle is used under aseptic conditions. A 20-mL syringe containing 5 mL of RPMI-1640 tissue culture medium is connected to the needle. Ultrasound guidance may be used on the rare occasions when the graft is not easily palpable [8].

Monitoring of other products of inflammation such as neopterin and lymphokines continues to be explored. It has been shown that acute rejection is associated with elevated plasma interleukin (IL)-1 in azathioprine-treated patients and IL-2 in cyclosporine-treated patients. IL-6 is also increased in the serum and urine immediately after transplantation and during acute rejection episodes. The major problem, however, is that infection, particularly viral, can also elevate cytokine levels. Recently, polymerase chain reaction (PCR) has also been used to detect mRNA for IL-2 in fine-needle aspirate of human transplant kidney [7,8]. Using the PCR approach, IL-2 could be detected 2 days before rejection was apparent by histologic or clinical criteria. Reverse transcriptase-PCR has also been used to identify intrarenal expression of cytotoxic molecules (granzyme B and perforin) and immunoregulatory cytokines (IL-2, -4, -10, interferon gamma, and transforming growth factor-^) in human renal allograft biopsy specimens [9]. Molecular analyses revealed that intragraft display of mRNA encoding granzyme B, IL-10, or IL-2 correlates with acute rejection, and intrarenal expression of transforming growth factor (TGF)-^1 mRNA is associated with chronic rejection. These data suggest that therapeutic strategies directed at the molecular correlates of rejection might refine existing antirejection regimens.

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