IS UREMIA IMMUNOSUPPRESSIVE IN RENAL TRANSPLANTATION?

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Abstract
The impact of post-transplantation uremia on the antiallograft immune response was quantitated by transplant aspiration cytology. Renal transplant patients (64), treated with a similar immunosuppressive regimen, were aspiration biopsied at 2-day intervals during the 1st 15 days postoperatively. The patients were allocated into 3 groups on the basis of their serum creatinine level on the 3rd postoperative day: transplants with a delayed onset of function (highly uremic group, serum creatinine level .gtoreq. 600 .mu.mol/l; 24 cases), transplants with a partially delayed onset of function (partially uremic group, 200-600 .mu.mol/l; 21 cases), and transplants with an immediate onset of function (nonuremic group, .ltoreq. 200 .mu.mol/l; 14 cases). These 3 groups were comparable in respect to the mean age, sex ratio, number of HLA-ABC mismatches (DR was not typed), number of pretransplant blood transfusions, and underlying diseases. Seventy percent of the transplants in the highly uremic group, 60% in the moderately uremic group and 60% in the nonuremic group underwent an early inflammatory episode during days 0-15 post-transplantation. The date of onset of inflammation was not significantly different in the 3 groups. The size and type of inflammation were significantly different: compared with the transplants in nonuremic patients, the total inflammatory response was slightly (P = 0.272) depressed in the transplants of moderately uremic patients and significantly (P = 0.007) depressed in the transplants of highly uremic patients. This depression was attributable to the depression of the blastogenic response: compared with nonuremic patients the blastogenic response was distinctly (P = 0.059) depressed in the moderately uremic group and significantly (P = 0.003) depressed in the highly uremic group. The frequency of in situ macrophages was the same in the 3 groups, or moderately elevated in the highly uremic group (P = 0.079). The graft survival was only 40% in the highly uremic group compared with 79% in the nonuremic controls and 81% in the moderately uremic patients (P = 0.016). Post-transplantation uremia apparently partially impairs the antiallograft immune response, but this impairment is so small that other factors, whose nature cannot be explained on the basis of the present results, overrule the effects of uremia on graft survival.

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