Early prediction of acute rejection (AR) and overall renal allograft function is crucial for appropriate management considering long-term outcome of KT. Kidney transplantation (KT) is the final and definitive treatment option for end-stage kidney disease (ESKD) patients. One-week post-KT urinary MCP-1 may be used as a noninvasive diagnostic marker for predicting AR after LDKT. Post-KT 1 week urinary MCP-1 showed predictive value in the validation cohort. Urinary fractalkine, MCP-1, and IL-10 showed positive correlation with intrarenal leukocyte infiltration.
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Intrarenal total leukocytes and T cells were elevated in the AR group compared with the control group. Urinary MCP-1, fractalkine, TNF-α, RANTES, and IL-6 after one week were significantly higher in the early AR group. Urinary MCP-1 after one week was higher in the AR group. Urinary MCP-1 and fractalkine were also analyzed in a validation cohort. Intrarenal total leukocytes, T cells, and B cells were analyzed with immunohistochemistry followed by tissueFAXS. Serum and urine cytokines/chemokines were measured serially as follows: intraoperative, 8/24/72 h, 1 week, 3 months, and 1 year after LDKT. Early AR was defined as AR occurring within 3 months.
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Patients were divided into control (n = 42) or acute rejection (AR, n = 35) group. This prospective cohort study included 77 LDKT patients who were followed for ≥ 5 years. We investigated the clinical relevance of urinary cytokines/chemokines reflecting intrarenal immunologic micromilieu as prognostic markers and the optimal measurement timing after living donor kidney transplantation (LDKT).