We have tested an immune monitoring program consisting of cytofluorometric analysis of lymphocytic and monocytic markers, using a set of different monoclonal antibodies (mAb), in about 500 transplant patients including about 300 long-term renal allograft recipients. The high sensitivity (95%) of these cytofluorometric analyses in the peripheral blood allows to discriminate between acute rejection and other causes of deteriorated kidney transplant function (infection, toxicity, arteriopathy), especially in the late phase ( > 1 year) after transplantation. Additionally, the immune monitoring is sufficient to predict success of antirejection therapy as early as a few days after onset of treatment. A life-threatening complication in allograft recipients is septic disease. Proceeding from immune parameters, septic patients were found to fall into two categories: those with decreased expression of HLA-DR on monocytes ( < 20%, termed as ‘immunoparalysis’) and patients with nearly normal HLA-DR+ monocytes. Septic immunoparalysis requires drastic reduction of immunosuppression (mortality after drastic reduction: 8%; after marginal reduction or without reduction: 90%). We have not observed severe rejection as a consequence of reduced immunosuppression in such patients. Our immune monitoring seems to be useful for management of immunosuppression in patients with unclear deterioration in graft function as well as patients with septic complications in order to minimize two risks, i.e. death by sepsis or loss of graft.

Keywords:
Kidney transplantation, Immune monitoring, Rejection, Sepsis, HLA-DR+ T lymphocytes, HLA-DR+ monocytes
This content is only available via PDF.
© 1992 S. Karger AG, Basel
1992
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.