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NDT Advance Access published online on February 17, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp045
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Monocytes/macrophages in kidney allograft intimal arteritis: no association with markers of humoral rejection or with inferior outcome

Nicolas Kozakowski1, Georg A. Böhmig2, Markus Exner3, Afschin Soleiman1, Nicole Huttary1, Katalin Nagy-Bojarszky1, Rupert C. Ecker4, Zeljko Kikic2 and Heinz Regele1

1 Clinical Institute of Pathology 2 Departments of Internal Medicine III 3 Laboratory Medicine, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna 4 TissueGnostics GmbH, Taborstraße 10/2/8, A-1020, Vienna, Austria

Correspondence and offprint requests to: Heinz Regele, Department of Pathology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria. Tel: +43-1-40400-5176; Fax: +43-1-40400-5193; E-mail: heinz.regele{at}meduniwien.ac.at



  Abstract

Background. Several studies indicate that interstitial and intracapillary monocytes/macrophages (MO) represent a significant proportion of graft-infiltrating cells in renal allografts and that their presence may unfavourably affect clinical outcome. Much less is known about the role of MO in vascular rejection of transplanted kidneys. The aim of our study was to determine the cellular composition of immune cell infiltrates in intimal arteritis and to analyse whether it is associated with features of humoral immunity and impaired graft survival.

Methods. In 34 recipients with vascular rejection, we determined the proportion of intimal and interstitial MO and T-cells (expressed as ratio of CD68- and CD3-positive cells) in immunohistochemically double-labelled slides.

Results. Intimal arteritis is always composed of T-cells and MO with a median CD68/CD3 ratio of 1.03. In 47% of cases, however, T-cells predominate (CD68/CD3 ratio <1). The median interstitial CD68/CD3 ratio is 0.61, with T-cells dominating in 64% of cases. There is no correlation between the cellular composition of arterial and interstitial infiltrates. The proportion of interstitial and arterial MO has no impact on graft survival, and is, in contrast to previous reports on MO in allograft glomerulitis and capillaritis, not associated with C4d staining.

Conclusions. Intimal arteritis in kidney allograft rejection is composed of a mixed infiltrate of MO and T-lymphocytes. In contrast to MO in PTCitis and glomerulitis, the MO in intimal arteritis are not associated with markers of humoral immune response and there are no different allograft outcomes between MO and T-lymphocyte-dominated groups.

Keywords: intimal arteritis; kidney allograft; lymphocyte; macrophage; monocyte

Received for publication: 1.11.08
Accepted in revised form: 22. 1.09


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