[Immunologic reactivity in children on a chronic dialysis program and after kidney transplantation]

Dialysis and transplantation of the kidney have become in Czechoslovakia part of routine therapy of chronic renal failure (ChRF) in children and adolescents. The authors examined 16 children aged 4-17 years (x = 10.5) treated in a chronic dialyzation programme (ChDP) by haemodyalisis and 20 children after transplantation of a cadaverous kidney, age 4.5-16.5 years (x = 11.5), incl. 14 patients with a stable function of the graft and six patients during the period of acute rejection of the graft. The authors tested the basic parameters of humoral and cellular immunity in all three groups of children. In the group of the CRI a significant drop of the level was found only in serum IgA, the other parameters, incl. examination of sub-populations of lymphocytes CD3+, CD4+ and CD8+, did not differ significantly from normal values. In patients with a stabilized function of the graft treated by Cyclosporin A, prednisone, and in some cases also with azothioprim, the authors found a significantly lower absolute number of lymphocytes of the mentioned sub-populations as compared with controls and patients included in a ChDP. During the period of acute rejection the absolute number of CD3+, CD4+, CD8+ increased significantly, as compared with the period of stabilized function of the graft. Thus patients in CRI do not manifest despite the serious affection of the organism serious changes of immune reactivity within the scope of examinations made by the authors. Monitoring of immunity parameters in patients with transplants can contribute to evaluation of the effect of immunosuppression (it can draw attention to low dosage of drugs) and in the context with other clinical and laboratory examinations it can contribute to the diagnosis of acute rejection.