| BackgroundAfter a half century of development, renal transplantation has become to be the most effective therapy for chronic kidney failure,but the actue rejection(AR) may be the most important factors that led to the allograft dysfuction.There many ways to diagnose acute rejection,such as the increment of the basal serum creatinine level、a decrease in urine output、the ultrasound and the magnatic resonance imaging of transplantation renal et al. The renal allograft biopsy also can early detection of acute rejection and even be considered of the "gold standard"of diagnosis acute rejection. But most these mays can not diagnose acute rejection before allograft damage,kidney biopsies belonging to a invasive test can do it. Due to the ultrasound,fine neddle aspiration biobsy(FNAB) of renal allograft can be repeated,FNAB still has certain complications,such as:puncture point bleeding, hematoma,gross hematuria and even renal allograft rupture risks.MRI can also early detection of actue rejection and may cause nephrogenic systemic fibrosis(NSF) and other serious complications. So how to find a non-invasive method for early diagnosis and cure of acute rejection is still an important subejct, which can improve the allograf’s and recipients’s long-term rates and quality of life.CD20-positive cell infiltrates in allograft and high levels of urinary CD20mRAN correated with actue rejection and poor graft outcomes.CD20is expressed as a cell surface antigen on B cells from pre-B cells to the memory B cell but not normal plasma cells and play an important role in allograft rejection,such as:①Participate in B cell activation and proliferation;②CD20+B cells are also an important source of cytokines which could potentially drive ongoing recalcitrant T cell activation,inflammation and AR.The aim of our study was to investigate if detection of soluble CD20in peripheral blood of renal transplant patients with acute rejection and allograft dysfunction.Objective1To research the expression of CD20in a human transplantation renal and the expression of sCD20in peripheral blood of the human renal transplantation.2To study t the relationship between the level of sCD20in peripheral blood and the prognosis of the transplant kidney.Methods1Collecting caseFrom January2007to December2010,there were98patients underwent kidney transplantation in our hospital. Blood samples of these patients were analyzed by obtained before transplantation and on day7after transplantation.50patients were chosen include25cases had been diagnosis of acute rejection and25cases were not happened. Follow-up was taken at least6months and we collected graft function failure patients. Also25health people of the voluntary blood donation were taken.2The expression of soluble CD20in peripheral bloodThe experiment was divided into three groups,the first group is acute rejection group which had been diagnosis of acute rejection,the second group is stable group which did not happen acute rejection,the third group is normal control group which was health people. ALL the expression of soluble CD20in peripheral blood at this three groups were detected by ELISA.3The expression of CD20in patient transplantation renalFrom January2007to December,excisional renal tissues were imbedded in a paraffin,sliced into sections and received immunohistochemistry.The expression of CD20was detected in excised renal tissues.4To analyze the correlation between soluble CD20in peripheral blood and renal graftsurvivalThe expression of soluble CD20in peripheral blood at these50patients was detected by ELISA, the correlation between soluble CD20in peripheral blood and Cr were analyzed. The correlation between soluble CD20in peripheral blood and the expression of CD20in patient transplantation renal which was detected by immunohistochemistry were also analyzed.Results1The expression of soluble CD20in peripheral blood before operationBefore renal transplantation, the expression of soluble CD20in AR was1750.60±359.59ng/ml,the stable patients was936.96±181.71ng/ml and the health people was919.37±245.46ng/ml.These three datas were analyzed by one-way ANOVA.The differences of the expression of CD20between AR and stable group were significant,the differences of the expression of CD20between AR and nomal group were also significant,but there were no differences of the expression of CD20between stable group and nomal group. The creatinine was954.77±89.28μmol/L in AR pre-transplant patients. The creatinine was938.15±66.07μmol/L in stable group pre-transplant patients and68.08±15.67μmol/L in normal huaman. These datas were analyzed by one-way ANOVA. The differences of creatinine were not significantly between AR and stable groups.2The expression of soluble CD20in peripheral blood on7th day after renal transplantationOn7th day after renal transplantation, the sCD20in AR group is2516.20±511.33ng/ml and989.40±215.78ng/ml in stable group, the matching t test is used to compare the differences of the sCD20in AR before renal transplantation and after renal transplantation, the differences were significant.The same method was used compare the differences of the sCD20in stable group and there were no differences.3The correlation between soluble CD20in peripheral blood and Cr on7th day after renal transplantationOn7th day after renal transplantation, the sCD20in AR group is2516.20±511.33ng/ml, the Cr is656.20±152.54umol/l. The correlation between soluble CD20in peripheral blood and Cr, The expression of sCD20was positive correlation with Cr.4The expression of CD20in renal tissuesThere were8allograft dysfunction patients between January2007and December2010,5patients were positive for CD20staining (The biopsy samples were considered positive for CD20staining (CD20+) if there was at least50positive cells/HPF,and negative if less than50cells/HPF(CD20-)),3patients were negative for CD20staining. CD20expressed in renal tubules and interstitial,the levels of soluble CD20in peripheral blood on7th day were2798.22±692.54ng/ml for CD20+group,and1435.78±470.55ng/ml for CD20-group, the differences were significant.Conclusion1Our study had showed that the expression of soluble CD20in peripheral blood were higher in AR group before and after renal transplantation.The differences of the expression of CD20were significantly between AR and control group. 2After renal transplantation, the expression of soluble CD20in peripheral blood on7th day was significant increase in AR group,but the increase was not significant in stable group.3On7th day after renal transplantation, the expression of sCD20was positive correlation with Cr.4The CD20+group most had higher expression of soluble CD20in peripheral blood which characterized by poor to conventional anti-rejection treatment,so sCD20may correlate with the treatment of AR.5Detecting the expression of soluble CD20in peripheral blood may a non-invasive and simple method for early diagnosis of acute rejection. |
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