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Mast cell numbers and protease expression patterns in biopsy specimens following renal transplantation from living‐related donors predict long‐term graft function

Abstract:  In human kidney transplantation the main cause of declining long‐term graft function is chronic allograft nephropathy (CAN). Recent studies have implicated human mast cells (MC) in chronic inflammation and fibrosis, MC can be subtyped according to protease content: MCT containing tryptase only and MCTC containing both tryptase and chymase. We investigated immunohistochemically whether numbers and subtypes of MC in biopsy specimens 100 d after transplantation could predict subsequent fibrosis and graft dysfunction. The total number of MC/high‐power field at 100 d after transplantation correlated significantly with change in creatinine clearance (ΔCcr), defined as (Ccr at 100 d) − (Ccr at 3 yr) (R = 0.597, p = 0.0021); fibrosis index (FI) at 100 d (R = 0.583, p = 0.0066); and ΔFI, defined as (FI at 3 yr) − (FI at 100 d) (R = 0.406, p < 0.05). The ratio of MCTC to total MC at 100 d also correlated with ΔCcr (R = 0.491, p = 0.0148), FI at 100 d (R = 0.527, p = 0.0081), and ΔFI (R = 0.417, p < 0.05). Thus, increases in number of total MC and the ratio of MCTC to total MC in early biopsy specimens were related to decline of long‐term graft function and fibrosis.