[Immunologic and clinical definition of the rejection reaction in kidney transplantation]

In the evaluation of the immunological state of a kidney transplant there is no reliable diagnostic test. Therefore, several various tests should always be applied. The aim of this study was to define the type of immunological reaction (cellular or humoral) that causes the rejection of transplanted kidney. A group of 45 patients with a kidney transplant were tested 175 times, in various phases of the kidney transplant, starting on the day of transplantation up to several months posttransplant. Specific antibodies (SA) and specific cytotoxic lymphocytes (SCL) directed against donor cells in lymphocyte-mediated cytolysis tests in the presence of antibodies (ADLMC) or without them (LMC) were determined. LMC was significantly correlated with acute rejection (85%). In the phase of clinical quiscence of the kidney transplant LMC was positive in 4% of the cases. During the period of chronic rejection it was positive in 75% of the cases. ADLMC test is significantly correlated with chronic rejection (88%). In the period of acute rejection it was positive in 27% while in clinical quiscence in 11% of the cases. Twenty-two patients with non-immunological disorders of the kidney transplant were tested 62 times. LMC test was always negative, while ADLMC test was positive in 6.4% of the cases. These tests prove to be good parameters for defining immunological reaction. Thus, they can be of great importance in determining adequate immunosuppressive therapy. Negative results of tests in non-immunological disorders of graft function are highly significant.