Recipient and donor gene polymorphisms

In a recent study by Hoffmann et al. (2003) where they compared patient and donor allelic genotypes in renal transplant patients and established phenotypes to allograft status as defined by Banff criteria in serial protocol biopsies (Racusen et al., 1999). They showed that high production alleles for either IL-10 or IFN-gamma were dominant in recipients with Banff criteria for chronic changes compared to a control group. They also showed that in the rejections patients that were resistant to initial steroid therapy alone, those individuals were of the high IFN-gamma producer phenotype. Not only recipient but donor related factors, in particular the age and ethnicity of the donor can play a role in an early rejection episode (Marshall et al., 2001; Swanson et al., 2002; Verran et al., 2001). Donor brain death and allograft ischemia are a traumatic process that can affect cytokine production (Pratschke et al., 2000). The impact of high donor IFN-gamma and IL-10 production was shown to be significant (Hoffmann et al., 2003) on recipients presenting with sub-clinical rejection, ACR or chronic changes when compared to those donors with stable recipients and normal allograft histology. These results suggest that donor-derived production may play an essential role in inflammatory processes initiating rejection. Given the shortage of suitable donor organs, the acceptance of organs from marginal donors is rising, warranting an assessment of donor specific variables (Gjertson et al., 2002; Randhawa, 2001).

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