Enhanced renal allograft survival from azathioprine/steroid modified antibody-dependent cellular cytotoxicity

Serial antibody dependent cellular cytotoxicity (ADCC) effector cell function estimates and renal biopsies were obtained from 74 recipients to determine the ADCC modifications induced by azathioprine/steroid therapy and the histological character of rejection associated with the modifications. Recipients with suppressed ADCC did not experience rejection episodes while recipients with non-suppressed ADCC suffered graft failure following steroid-resistant rejection. The majority of recipients experienced reversible rejection episodes which were preceded by increased ADCC activity in the five day period preceding the commencement of high-dose steroid anti-rejection therapy. It was concluded that ADCC was active in the rejection process, and that in vitro ADCC measurement provided a means of monitoring the modifications induced by azathioprine/steroid therapy which promote a post-graft term free of rejection episodes.