Epstein-Barr virus infection is associated with endothelial Bcl-2 expression in transplant liver allografts.

INTRODUCTION: In liver transplant recipients with Epstein-Barr virus (EBV) disease, we reported a low rate of acute rejection after stopping or markedly lowering immunosuppression. This observation led to the hypothesis that EBV, as a means of viral persistence, induces expression of antiapoptotic factors and these factors, in turn, confer protection to the transplanted organ. Bcl-2, an antiapoptotic factor induced by EBV in various host cells, is not normally expressed in the liver. We questioned whether bcl-2 is expressed in the transplanted liver and whether its expression is modified by EBV. MATERIALS AND METHODS: Retrospective liver biopsy specimen from liver transplant patients diagnosed with EBV (n=12) were examined for the presence of bcl-2 by immunohistochemistry and compared with EBV (-) transplant (n=15), and nontransplant (n=13) livers. RESULTS: The most significant finding was the presence of endothelial bcl-2 expression in the majority of EBV (+) transplant samples examined (67%) and its relative absence in the other two groups (P<0.005). There was also bcl-2 expression in the hepatocytes and lymphocytes of the majority of transplant liver samples, irrespective of EBV status. DISCUSSION: We have identified a strong association between EBV infection and endothelial bcl-2 expression in transplant livers. We also found that transplantation, in itself, was associated with bcl-2 expression in the hepatocytes and lymphocytes of liver allografts.

Excellent outcome in recipients of dual kidney transplants: a report of the first 50 dual kidney transplants at Stanford University.

HYPOTHESIS: Recipients of dual kidney transplants from older expanded criteria donors (ECDs) have outcomes similar to recipients of single kidneys from younger donors. Dual transplantation is the use of both adult donor kidneys into a single adult recipient. DESIGN: Donor and recipient variables were entered into a database. Analysis was performed in a retrospective fashion. The unpaired t test and chi2 test were used as appropriate. SETTING: A university teaching hospital. PATIENTS: All adult recipients of cadaveric kidney-only transplants from adult donors between November 1991 and January 1999. Patients were grouped based on whether they received a dual or single transplant and whether the donor was an ECD. The control group of patients received non-ECD cadaveric kidneys. RESULTS: Donors for recipients of dual kidneys were older and had a lower creatinine clearance on hospital admission than recipients of single control kidneys. Recipients of dual transplants were older, had fewer rejections, and had similar 3-month and 1-year serum creatinine levels vs controls. Predictors of an elevated serum creatinine level or graft loss at 3 months in recipients of ECD dual and single transplants included kidneys from donors with unstable preprocurement renal function, and recipients who developed delayed graft function. CONCLUSION: Recipients of dual kidney transplants from ECDs have excellent outcomes similar to recipients of single control kidneys.