PURPOSE: We performed this study to evaluate the value as early markers predicting the acute rejection and differential diagnosis with other causes of renal dysfunction. METHODS: Immunohistochemical stains for HLA-DR, ICAM-1, IL-2 and IL-4 were performed on 44 cases of implantation biopsies which were divided into cases with acute rejection (R group, 14 cases) and cases without rejection episode (N group, 30 cases), and 45 gun biopsies for renal dysfunction which divided into cases diagnosed as rejection (A group, 28 cases) and cases diagnosed as other causes rather than rejection (B group, 17 cases). We analysed immunohistochemical results, various clinical datas such as age and sex of donor, living or cadaveric status of donor, the mean number of HLA-DR mismatch, age and sex of patient, serum creatinine level at post op 2 day for implantation biopsy and at the day on biopsy for renal dysfunction between above groups. RESULTS: 1) In 44 cases of implantation biopsies, positive immunohistochemical stains for HLA-DR were more frequent in R goup (71.43%) than in N group (26.66%). There was no significant difference of clinical datas and immunohistochemical stains for ICAM-1, IL-2 and IL-4. 2) In 45 cases of gun biopsies for renal dysfunction, immunohistochemical stains for HLA-DR were all positive in A group (100%) with higher rate of 3 stains (39.28%) than B group (positive; 70.58%, 3 ; 5.88%). Immunohistochmical stains for ICAM-1 were more frequently expressed in A group (100%) than B group (76.47%). Both stains revealed no significant difference according to the grades of rejection, disease other than rejection. There was no significant diffrence of immunohistochemical stains for IL-2 and IL-4, and clinical datas between two groups. CONCLUSION: We can conclude that the immunohistochemical stains for HLA-DR on implantation biopsies may predict the devepoment of the acute rejection and the immunohistochemical stains for HLA-DR and ICAM-1 on gun biopsies at the time of renal dysfunction may differentiate the reje.

PURPOSE: Transplantation of pancreas islet has been worldwidely studied as a one of therapeutic modalities to achieve the insulin independence. We studied whether the expression of vascular endothelial growth factor (VEGF) on pancreas islets with liposomal VEGF gene transfer could improve the efficacy of early implantation and long term graft survival in pancreatic islet cell transplantation. METHODS: Syngenic pancreas islets were transplanted beneath the renal capsule. Islets were transfected with plasmid VEGF c-DNA using cationic liposome DMRIE-C. Glucose metabolism and histologic findings were compared between the groups transplanted with VEGF DNA containing islets (n=5) and the control group with (n=5) or without (n=4) local recombinant VEGF adminstration during islet transplant. RESULTS: Glucose was controlled at 5.5 days after transplantation in control group without r-VEGF adminstration, at 4 days in group with recombinant VEGF adminstration, and at 6.6 days in group with VEGF DNA transfected islets. Euglycemia was maintained over 150 days in control group. However, graft failure was developed in 22 days after transplantation in group with VEGF DNA transfected islet. Histologically there were severe infiltrations of neutrophil and lymphocyte in VEGF DNA transfected grafts from 5 days after transplantation. CONCLUSION: Although VEGF could be a favorable angiogenic factor in pancreas islet transplantation, VEGF expression following VEGF DNA transfection into islets could not increase the graft survival due to inflammatory process. More investigations are needed to clarify the mechanism on destructive process of islets after gene transfection into islets, and another approaches to get the effect of gene transfection should be followed.