engleski

PRE-TRANSPLANT AND POST-TRANSPLANT DONOR-SPECIFIC CYTOTOXIC AND HELPER T- LYMPHOCYTE PRECURSOR FREQUENCIES AS MEASUREMENT OF CELLULAR ALLOIMMUNITY IN RENAL ALLOGRAFT RECIPIENTS.

Graft survival for solid organ transplantation (Tx) procedures is restricted by acute and chronic rejection. PreTx and post Tx antibody (PRA) testing is predictive parameter for risk of antibody- mediated graft injury. In the direct allorecognition pathway, T cells recognize intact donor major histocompatibility complex (MHC) molecules on donor cells and provoke strong in vitro response. Measurements of early frequencies of cytotoxic (CTLp) and helper T (Thp) lymphocyte precursors could be immune parameter that predicts graft outcome and hyporesponsive state with well function. In the present study we compared and evaluated whether the presence pre and post Tx frequencies identify recipients of a deceased donor at risk for early acute rejection. Peripheral blood lymphocytes from 86 renal allograft recipients were studied against splenocytes of original donor. Samples were collected on day 0, -14, -30 and 6 month. Mean ages of recipients were 38, 8 13, 0 y, female 24%, donor age 35, 8 13, 3 y and same ethnicity. Immunosuppression was heterogeneous. For statistical difference Cox regression was used. The results were correlated with graft rejection and serum creatinine (sCr). Differences in Thp frequencies reach significance on day 0 (p=0, 022) and day 14 post Tx (P=0, 038). In recipients with acute rejection pre Tx vs. non-rejection group mean value was 160, 91 244, 04 ; max 1039 vs. 81, 68 85, 68 ; max 328. Recipients undergoing rejection episodes had higher fThp (177, 59 249, 64 vs. 75, 95 71, 08). After 30 days and 6 month where decrease in fThp in both groups of recipients. With respect to CTLp incidence of statistical significant differences are present during 1 month. Pre Tx CTLp frequencies differ in testing groups with P=0, 009, after 14 days P=0, 015 and after 1 month difference between recipients with acute graft rejection and without is with P=0, 018. Logistic regression showed that rejection group of recipient s 14-day post Tx (P=0, 015) and sCr (P=0, 005) had significant correlation. Positive recipients after 1 month (P=0, 018) had sCr baseline significant (P=0, 091). Our results suggest that pre Tx frequencies of donor specific Thp and CTLp independently predict acute rejection. In addition, post Tx measurements provide information of hyporesponsive state of recipient and could be used to individualize post Tx immunosuppression.

cytotoxic and helper lymphocyte precursors; renal transplantation

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