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(INS) BY GLOBAL GENE PRORLING. &. Song1,N. ~ e ' D. , C. ~attran'?.J. K O ~ D ~P., ~ t . ~ e o r ~ e - ~ vS.s l o ~ ~ .
~ e andr Y,~ ~ e i ' . '~ivision
~. of Nephrology and 2~epartmentof Medicine, University Health Network and
University of Toronto, Toronto, Ontario, Canada; and 3 ~ i d n e Disease
y Section, National Institutes of Health,
Bethesda, MD, United States.

INS is an important clinical problem of diverse etiologies. Steroid-sensitiveminimal change disease (SS-MCD)
and focal segmental glomerulosclerosis(SS-FSGS) are two important causes of INS currently thought to be the
result of a primary T-cell immune disorder. By contrast, some cases of steroid-resistant (SR) FSGS are due to
germline mutations of podocyte-specific proteins.
We sought to determine if there are disease-specific gene clusters in peripheral blood mononuclear cells (PBMCs)
associated with SS-INS. We collected PBMCs from patients with newly onset or relapsing SS-FSGS (n=ll) and SS-
MCD (nt6) before or at least 6 weeks off all irqtnunotherapy, SR-FSGS (n=4) and other glomerular diseases such as
diabetic nephropathy and membranous glomerulonephritis (n=8; as control for non-specific gene expression
associated with NS). We isolated total RNA from CD4+ve T cells, CD8+ve T-cells and macrophageslmonocytes,
after their separation by magnetic cell sorting using specific monoclonal antibodies. Using oligonucleotide
microarrays (human genome U133A, Affymetrix), we compared the global expression patterns of 18,400 annotated
genes or ESTs in our study patients. Using the software packages Genes@work and Significance Analysis of
Microarrays (SAM; with a false discovery rate set at -5%), we found a molecular signature profile (MSP) of -200
genes (involved in response to external stimulus n=15, signal transduction n=32, metabolism n=99, response to
stress n=7, transport n=25, cell cycle n=8, cell proliferation n=16, apoptosis n=5, etc.) which characterize a subset of
patients with SS-FSGS (n=7) and SS-MCD (n=4).
Our data support the notion that SS-MCD and SS-FSGS can represent variable phenotypes from a distinct
pathological process. Moreover, our data also suggest etiological heterogeneity within the syndrome of SS-
MCDISS-FSGS. Additional microarray analysis in CD8+ve cells in the same patients and replication of our findings
in an independent cohort of patients with SS- and SR-FSGS will be conducted in future studies. The identification of
disease-specific MSP(s) may provide the basis for developing clinical predictive tests to optimize the management
of patients with idiopathic FSGS.

Razmkon. A.R. Mehdizadeh. S.A. Malek-Hosseini. G.A. Raiss Jalali. S. Behzadi, H. Salahi, A. Bahador, M.
Salehi~oor.H.R. Davari, M. Sagheb,. Shiraz Organ Transplant Center, Nemazee Hospital, Shiraz, Iran.

The increasing number of the aged population in the world has put forward the issue of renal transplantation
elderly recipients. However, most studies in developed countries have demonstrated a lower graft survival,
patient death as a cause of graft loss in elderly patients. This study presents results of elderly renal grafts
1041 consecutive operations in Shiraz (Southern Iran) organ transplant center, with a minimum follow-up peri
12 months. Surgical techniques and immunosuppressive protocols have been the same in all age groups.
Among 1041 consecutive recipients, 120 (1 1.5%) were 50 or more years old (the elderly group); most recipie
(56.5%) belonged to the 16-40 age group. The elderly group consisted of 76.7% males and 23.3% females; don
in this group were 56.7% living-unrelated, 33.3% living related and 10.0% cadavers; the number of living-
donors is significantly higher than other age groups. Mean days of hospitalization was almost the same
days) in all age groups.
Rejection rate was significantly less in the elderly group (6.6% vs. 12.5%) which confirms other studies. Wowe
ATN, major urological complications needing intervention, infectious complications (mainly UTI)
cardiovascular problems occurred significantly more in the aged group. The I-, 2-, and 3-year patient survival r
in the elderly group were 9396, 91%, and 88%, respectively. Corresponding data in other age groups were 9
92%, and 91%. Most common causes of death were ATN and infectious complications. The data show a
patient survival in the elderly; however, in contrast to other studies, patient death due to factors other than
triggered by transplantation occurred not more than in other groups. Lower incidence of rejection may all
reducing immunosuppression which can help in minimizing infectious complications as a major cause of death.