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The aim of this study was to evaluate the effect of HLA-matching and donor type on recurrence of amyloidosis after renal transplantation. Thirty patients with systemic amyloidosis who received kidney transplants between 1985 and 2001 were included. Donor source and HLA tissue typing of the donor and recipient were evaluated in each case. Twenty of the 30 patients developed biopsy-confirmed recurrence of amyloidosis in their allografts. The time from transplantation to diagnosis of amyloidosis in the graft ranged from 18 months to 10 years. Eighteen of the 20 patients with recurrence had received their grafts from living-related donors (LRDs), and two had received their grafts from cadaveric donors. There was a strong correlation between amyloidosis recurrence and degree of HLA-DR matching (P <0.05). Further, in the recipients of the LRD grafts, the risk of amyloidosis recurrence was significantly higher when the donor-recipient pair were HLA-identical than when they were not perfectly matched ( P <0.01). The incidence of amyloidosis recurrence in our cases was significantly higher than the rates reported for other series. Most of the cases in previous reports involved cadaveric grafts. The higher rate of amyloidosis recurrence in our cases may be explained by the high proportion of LRD grafts, and by genetic susceptibility. [ABSTRACT FROM AUTHOR]

Research on renal biopsies has shown that HLA class I antigens are distributed throughout the renal parenchyma, but that the distribution of HLA-DR varies greatly. We investigated HLA-DR expression in the biopsies of 90 renal transplants, and also semiquantitatively assessed the proportions of CD68-, CD3-, and HLA-DR-positive infiltrating cells by immunohistochemistry. The relationships between tubular DR expression and interstitial lymphocyte and macrophage infiltration were examined. Forty of the biopsies showed acute rejection (AR), 33 showed chronic rejection (CR), 10 showed suspected rejection (SR), and seven showed no evidence of rejection (NR). HLA-DR expression was noted in 35/40 (87.5%) of the AR cases, 22/33 (66.6%) of the CR cases, and 6/10 (60%) of the SR cases. Only one (14.3%) of the NR cases exhibited HLA-DR antigen expression in the renal tubules. The proportions of lymphocyte and macrophage infiltration observed in the interstitium were significantly correlated with the tubular DR expression in all cases (P <0.01). Six months after the biopsies were carried out, 24/35 (68.6%) of the AR patients with tubular DR expression showed second-episode rejection or deteriorated renal function. The remaining 11 AR cases with tubular DR expression had stable renal function at this stage. The cases that had no significant tubular DR expression had no problems with rejection or functional deterioration. These findings are consistent with the theory that expression of HLA-DR antigens on renal tubular cells may be a marker of rejection and poor graft outcome. [ABSTRACT FROM AUTHOR]

Although renal transplant recipients tend to exhibit similar clinical and immunological changes over time, some allograft biopsies show early interstitial fibrosis (IF). To evaluate the relationship between HLA-antigens and IF in renal allografts, we reviewed the HLA-A, -B, -DQ, and -DR antigens in 88 renal transplant recipients. For each antigen type, we determined the number of patients who did and did not possess the antigen. We then determined the mean time to onset of IF for each of these two groups, and statistically compared the means. In the second part of the analysis, we divided the 88 patients into those who did and did not show IF at 6 months post-transplantation, and then calculated the prevalence of each antigen type in the IF(+) and IF(–) groups. This same procedure was repeated with the patients grouped according to the presence of IF at 12 months post-transplantation. The groups of patients with HLA-B8, -B27, -DQ2, -DQ5, -DQ6, -DQ7, -DR4, -DR13, and -DR15, had significantly shorter times to IF onset after transplantation than the corresponding groups without these antigens (P <0.05). The groups that were IF(+) at 6 and 12 months post-transplantation had significantly higher frequencies of HLA-B8, -B27, -DQ2, and -DR4 than the corresponding IF(–) groups at these two timepoints ( P <0.05). The results indicate that any kidney recipient with these antigens is predisposed to developing diffuse IF in their graft relatively soon after transplantation. We conclude that although there is multiple etiological agents in the pathogenesis of IF one can not exclude a HLA association in such cases. [ABSTRACT FROM AUTHOR]

Abstract: Biliary atresia is defined as partial or total obliteration of the extra-hepatic bile ducts. In advanced cases, liver transplantation (LTx) is considered the most appropriate treatment. This report describes a female patient whose biliary atresia and subsequent cirrhosis required LTx at 1 yr of age. Macroscopic inspection of the hilar region of the native liver post-Tx revealed the formation of a pouch in the hepatic duct and a stone in the lumen of the portal vein. X-ray diffraction analysis showed that the stone was composed of cholesteryl cinnamate, gluconic acid phenylhydrazide, Na β broma-allyl mercaptomethyl penicillinate, and Al2O3 crystals. While the cholesterol component is a known element of gallstones, we attributed the Na β broma-allyl mercaptomethyl penicillinate to the patient's drug therapy. Our literature search revealed no previous record or crystallographic analysis of portal vein phlebolithiasis. In this report we describe this rare finding. [ABSTRACT FROM AUTHOR]

Provides information on acquired perforating dermatosis (APD), a term for all perforating skin disorders that occur in adulthood. Characterization of papulonodular skin diseases by hyperkeratotic plugs or crusts in which dermal connective tissues perforates the skin surface or is eliminated through epidermal channels; Role of fibronectin, a component of extracellular matrix proteins, in the pathogenesis of APD.

To evaluate the histologic changes in the livers of renal transplant candidates who were infected with hepatitis viruses, we performed a percutaneous liver biopsy in each of 74 regular hemodialysis patients. Forty percent of them were seropositive for the antibody to hepatitis C virus (anti-HCV) whereas 29.7% had anti-HCV and antibody to hepatitis B surface antigen (anti-HBs) concomitantly. Seven (9.5%) were seropositive for only hepatitis B surface antigen HBsAg. Histopathological examination revealed that 30% of patients had chronic active hepatitis (CAH), 11% had chronic persistent hepatitis (CPH), and 3% displayed histopathological evidence of cirrhosis. Eleven of 22 patients with CAH were positive for only anti-HCV, and 2 of 22 were positive for only HBsAg. One patient had HBsAg and anti-HCV together, and 8 of 22 had anti-HBs and anti-HCV concomitantly. None of the anti-HBs positive patients exhibited abnormal histopathological changes. We found no statistically significant difference in histopathological findings between the HBsAg positive and anti-HCV positive patients. As 32 of 74 patients (43%) had some degree of chronic liver disease, we concluded that it is prudent to evaluate liver histology in HBsAg and anti-HCV seropositive renal transplant candidates before transplantation.