Delayed cutaneous hypersensitivity and human renal allotransplantation.

Area of Science:

• Immunology
• Nephrology
• Transplantation

Background:

• Patients undergoing chronic dialysis often exhibit impaired immune function.
• Assessing cell-mediated immunity is crucial for predicting transplant outcomes.

Purpose of the Study:

• To evaluate the immunologic responsiveness of patients on chronic dialysis using DNCB reactivity.
• To determine the correlation between pre-transplant DNCB reactivity and subsequent renal allograft rejection.
• To explore the utility of serial post-transplant DNCB testing for rejection detection.

Main Methods:

• 154 patients on chronic dialysis were assessed for DNCB (2,4-dinitrochlorobenzene) reactivity.
• 71 renal allotransplant recipients were analyzed for correlation between pre-transplant DNCB response and graft survival.
• Recall-antigen testing and serial post-transplant DNCB responses were monitored in subsets of patients.

Main Results:

• Dialysis patients as a group showed significantly decreased immunologic responsiveness compared to controls.
• 19% of patients demonstrated an immunologic response and 12% an irritant response to DNCB.
• Pre-transplant DNCB reactivity strongly correlated with allograft rejection: 1-year graft survival was 78% for DNCB-negative, 29% for DNCB-positive, and 20% for DNCB-irritant responders.
• Pre-transplant recall-antigen testing did not significantly correlate with transplant outcomes.

Conclusions:

• Pre-transplant DNCB skin testing is a valuable tool for assessing host immune responsiveness in transplant candidates.
• DNCB reactivity predicts renal allograft rejection, enabling better patient selection and management.
• Serial post-transplant DNCB testing may aid in early detection of rejection episodes.