Pattern of cytokine expression in circulation CD57+ T cells from long-term renal allograft recipients.

We made a quantitative analysis of the lymphokine mRNA and of proteins produced by CD57+ and CD57- circulating T cells isolated from long-term kidney-transplanted patients with expanded CD4+/CD57+ and CD8+/CD57+ T cells, and from normal individuals. We concentrated on IL-2 and IFN-gamma, which define a Th1-like type of lymphokine production, and on IL-4 which defines a Th-2-like type. We also analysed the production of IL-10 which is endowed with inhibitory effects on IL-2 and IFN-gamma synthesis, and of TNF-alpha, a pleiotropic inflammatory cytokine. On ionomycin + PMA stimulation, which reveals the intrinsic potential of lymphokine production by T cells, the CD57+ T cell subsets from all individuals produced high amounts of IFN-gamma and TNF-alpha mRNA and protein. They also produced IL-2, but to a much lesser extend than their CD57- counterparts, and little IL-4 and IL-10. They were no more capable of producing IL-2 when stimulated through the CD3/TCR in the presence of monocytes, yet still synthesized IFN-gamma. Our data suggest that the in vivo expansion of CD57+ T cells in stable allograft renal recipients might correspond to Th1 energized cells which on triggering of cell surface receptors hardly secrete lymphokines involved in cell cycle progression, but can still exert some effector functions, including IFN-gamma secretion.

Artificial ureteral replacement for ureteral necrosis after renal transplantation: report of 3 cases.

PURPOSE: We applied a new minimally invasive technique of artificial ureteral replacement for renal transplant ureteral necrosis. MATERIALS AND METHODS: Artificial ureteral replacement was performed in 3 renal transplant recipients with ureteral necrosis (complete in 1 and distal in 2) after failure of primary endoscopic treatment. Under fluoroscopic guidance a percutaneous tract is created and progressively dilated. The ureteral silicone polytetrafluoroethylene bonded tube is introduced into the pyelocaliceal renal graft cavities, tracked subcutaneously down to the suprapubic area and introduced into the bladder via a short incision. RESULTS: There were no immediate postoperative complications except for transient postoperative acute prostatitis in 1 patient. No secondary complications were observed with a mean followup of 2.5 years. All grafts have good late function and all tubes are patent with no evidence of encrustation or obstruction. The tubes are well tolerated underneath the skin. Reflux was present in all 3 cases with no clinical manifestation. An asymptomatic episode of lower urinary tract infection was observed in the female patient. CONCLUSIONS: In select cases of ureteral necrosis after renal transplantation artificial ureteral replacement by subcutaneous pyelovesical bypass offers a possible alternative to open ureteral reconstruction.

The long-term virologic and pathologic impact of renal transplantation on chronic hepatitis B virus infection.

In an attempt to evaluate the long-term reciprocal impact of renal transplantation on hepatitis B virus infection, we analyzed the clinical, virologic, and pathologic features of 151 HBsAg-positive kidney transplant recipients. The spontaneous disappearance rates of HBsAg, HBeAg, and HBV DNA during a median follow-up of 125 months (range 1 to 320) were 3, 30.6, and 3%, respectively, figures lower than in the general population. A high rate of persistent viral replication (50%) and reactivation (30%) was noted. Noteworthy was the high frequency of histologic deterioration (85.3%), accompanied by cirrhosis in 28% and by hepatocellular carcinoma in 23% of the patients with cirrhosis. Co-infection by hepatitis C and B viruses was significantly associated with histologic worsening. Liver disease was the leading cause of death (36.6%), especially in patients with cirrhosis. Despite persistent viral replication, histopathologic deterioration, and liver-related overmortality, there were paradoxically no significant differences in the survival of these 151 HBsAg-positive compared with 1247 HBsAg-negative kidney recipients--however, allograft actuarial survival was better in the former than in the latter group (P=0.0006). Chronic hepatitis B infection is not a contraindication to renal transplantation in the absence of cirrhosis. The presence of cirrhosis should lead either to dialysis continuation or to a combined liver/kidney transplantation, in the absence of viral replication.