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IMMUNOLOGICAL MONITORING IN TRANSPLANTATION.

G S Chopra1, J R Bhardwaj2, N K Mehra3

  • 1Classified Specialist (Pathology), Army Hospital Delhi Cantt 110010.

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|August 4, 2017
PubMed
Summary
This summary is machine-generated.

Soluble interleukin-2 receptor (sIL-2R) levels indicate kidney transplant outcomes. Elevated sIL-2R signifies rejection or infection, while lower levels suggest a well-functioning graft.

Keywords:
AutoantibodiesImmunoglobulinsInterleukin-2Kidney transplantationReceptorsTransplantation immunologyTumor necrosis factor

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Area of Science:

  • Nephrology
  • Immunology
  • Transplantation Medicine

Background:

  • Live related donor renal transplantation (LRD) is a critical treatment for end-stage renal disease.
  • Monitoring immunological markers is essential for assessing graft health and predicting outcomes.
  • Soluble interleukin-2 receptors (sIL-2R) and tumor necrosis factor alpha (TNF-α) are key immune mediators.

Purpose of the Study:

  • To evaluate the diagnostic utility of sIL-2R, TNF-α, and specific autoantibodies in LRD recipients.
  • To correlate marker levels with graft function, rejection, and complications post-transplantation.
  • To assess the role of anti-IgG(Fab')2 and anti-IgG(Fc) autoantibodies in renal allograft outcomes.

Main Methods:

  • Prospective evaluation of 68 LRD patients at pre- and post-transplant intervals.
  • Measurement of serum sIL-2R, TNF-α, anti-IgG(Fab')2, and anti-IgG(Fc) levels.
  • Comparison of marker levels across different clinical scenarios: well-functioning grafts, rejection, infection, and nephrotoxicity.

Main Results:

  • Pre-transplant sIL-2R levels were significantly higher in patients awaiting transplantation compared to healthy controls.
  • Post-transplant sIL-2R levels were significantly lower in well-functioning grafts (WFG) compared to pre-transplant levels.
  • Elevated sIL-2R levels were observed in acute rejection, chronic rejection, and infections (p < 0.001).
  • Moderate sIL-2R levels were seen in CsA nephrotoxicity, ATN, and surgical obstruction.
  • TNF-α levels were elevated in rejection and infection but not statistically significant.
  • Higher anti-IgG(Fab')2 levels were associated with WFG.
  • High pre- and post-transplant anti-IgG(Fc) activity correlated with increased graft rejection and lower survival.

Conclusions:

  • Serum sIL-2R is a sensitive marker for monitoring renal allograft status, differentiating between well-functioning grafts and complications like rejection or infection.
  • Anti-IgG(Fc) autoantibodies may play a role in predicting graft rejection and poor graft survival.
  • Combined assessment of immunological markers can aid in personalized management of renal transplant recipients.