Serial immunologic studies in recipients of hepatic allografts

Thirty recipients of hepatic allografts had serial immunologic evaluations. Prior to transplant, patients had marked depression of lymphocyte subsets and impaired in vitro immunoglobulin synthesis, while phytohemagglutinin responsiveness was similar to that of controls. Following transplantation and introduction of cyclosporine and low-dose steroid therapy, there was a significant decline in both T cell subsets, but only the T4 population remained significantly depressed throughout the entire study period. The T4:T8 ratio in 5 patients who experienced acute rejection episodes was 1.4 +/- 0.6 prior to transplant. It increased to a mean of 2.0 +/- 0.6 by the time the diagnosis of rejection was made. By contrast, 12 subjects transplanted during a similar time period who did not demonstrate rejection had a T4:T8 ratio of 4.0 +/- 3.9 prior to transplant which fell to 1.5 +/- 0.6 (P less than 0.01) by 1 week post-transplant. In all 12 of these, the T4:T8 ratio fell in the 7 days post-transplant. The results indicate that monitoring the T4:T8 ratio in hepatic allograft recipients may be a useful marker for determining patients at risk for a rejection episode.