ORGAN‐SPECIFIC, ANTIRENAL CELLULAR HYPERSENSITIVITY AFTER KIDNEY TRANSPLANTATION

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Abstract
The in vitro reactivity of peripheral leucocytes to renal parenchymatous extract has been examined by means of a capillary tube migration technique (leucocyte migration test, LMT) in 34 patients who had received a renal transplant. In eight patients with uneventful course, and in the remaining 26 patients during uncomplicated periods (total of 206 observations), no inhibition of the migration was seen. During episodes with reduction in renal function the migration was inhibited in ten of 15 cases with acute rejection. In two cases of chronic rejection LMT was normal. Inhibition in the LMT was seen during two of seven episodes with leakage of the ureteral anastomosis. One of these patients had received a kidney from an identical twin, so ureteral rejection as the cause of the leakage could be excluded. Inhibition could also be demonstrated in a patient with recurrence of the original disease in the grafted kidney (glomerulonephritis). In six patients with transient ischaemic damage of the grafted kidney no inhibition was seen in the anuric period. The reactivity demonstrated in the present study thus indicates the development of organ‐specific, antirenal cellular hypersensitivity, possibly caused by disintegration of a proportion of the graft cells with release of kidney‐specific antigens. In the present modification the LMT seemingly does not reflect hypersensitivity to transplantation antigens for the following reasons: (i) No inhibition was seen with other tissue extracts (which might equally well contain transplantation antigens); (ii) foetal kidney extract was not able to produce transformation of lymphocytes in suspension culture; (iii) patients with active glomerulonephritis also show this reactivity. The conclusion is that LMT with foetal kidney extract reflects renal damage of different aetiology and is therefore of no practical value in the diagnosis of acute rejection after renal transplantation.