[Cell-mediated lympholysis in kidney transplantation]

Kidney transplant survival has been increased with the use of cyclosporine (CyA) and antilymphocyte globulin (ALG), in spite of which both significant morbidity and mortality persist. On the other hand, immunosuppression is mostly based on the state of renal function and not on the monitoring of immunologic parameters. Therefore, it is important to apply immunological techniques for early diagnosis of over-immunosuppression and eventually to stop maintenance immunosuppression completely. Seventeen kidney transplant recipients (3 from cadavers and 14 living related) were studied. They were initially treated with either 3-5 mg/kg/d CyA, ALG and 0.5 mg/kg/d prednisolone (current treatment) or with 2 mg/kg/d azathioprine and 1 mg/kg/d prednisolone (conventional treatment). Cell-mediated lympholysis (CML) was performed between receptor and, alternatively, specific donor and third unrelated control. CML figures were higher with conventional treatment (14.73 +/- 1.69) than with current treatment (3.14 +/- 0.8) (Table 2). CML responses between receptors and third unrelated donors increased significantly with conventional therapy to 77.67 +/- 8.17, a value not different from that encountered between unrelated controls (72.7 +/- 3.9). The CML responses with the current therapy increased significantly to 34.25 +/- 2.54 but remained lower than that observed in the other group. The data suggest that the use of GAL and CyA leads to a nonspecific decrease of the immune response. It remains to determine whether or not the pattern evolves later to a donor specific hypo-response, as observed in the present study with the group with conventional treatment, confirming previous results.