Background: Transplant recipients (RTx) of kidneys classified as extended criteria (ECD) seems to have worst outcomes when compared with RTx of standard kidneys (SCD) and there are not tools and markers for predict these outcomes.

Objectives: To evaluated the molecular inflammatory profile of ECD and SCD kidneys in pre-implantation (T0) biopsies and sought possible changes in this profile induced by different immunosuppressive drugs (ISS) after 15 (T15) and 90 days (T90) post-Tx.

Methodology: Prospective open label, randomized according to the donor type (ECD or SCD). 80 RTx received induction therapy with Basiliximab followed by maintenance ISS with Tacrolimus (TAC) or de novo Everolimus (EVL) used immediately after transplantation, associated with enteric coated Sodium Mycophenolate and Prednisone. Kidney biopsies (Bx) were performed at T0, T15 and T90 and the levels of mRNA expression of FOXP-3, MCP-1, RANTES, TGF-β and IL-10 were evaluated. Correlations were performed between inflammatory gene expression and donor and receptor clinical risk factors.

Results: 80, 64 and 51 Bx samples were obtained at T0, T15 and T90 respectively. T0 Bx from ECD showed higher expression of MCP-1, RANTES and IL-10 than SCD. RANTES was highly expressed in all time period biopsies of both types of kidneys, the highest levels observed in T90 Bx of SCD recipients treated with EVL and the lowest in T90 Bx of ECD-TAC. MCP-1 was highly expressed only in SCD kidneys regardless the ISS while FOXP-3 was predominantly expressed in EVL treated patients regardless the kidney type. No donor factor could be associated with the cytokines changes observed and no differences were found in renal function or graft survival in the first year.

Conclusions: T0 Bx of ECD kidneys have an inflammatory molecular profile. After transplant ISS did modify the pattern of cytokine expression and these changes are affected by the donor kidney type.

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