Diagnosis of renal transplant rejection in the cyclosporine era

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Abstract
The introduction in 1983 of cyclosporine as a prophylactic immunosuppressive agent has contributed to improved renal allograft survival at many transplant centers. However, in view of its profound nephrotoxic potential, the use of this drug in renal transplant patients has caused diagnostic confusion. An accurate assessment of whether the allograft dysfunction is from drug overdose or from acute rejection is important before one can manage the problem appropriately. The two practical measures that would help in distinguishing acute rejection from cyclosporine-induced toxicity are 1) a trial of cyclosporine dose-reduction and subsequent assessment of renal function, and 2) histologic assessment of the renal allograft biopsy specimen. In recent years, several new diagnostic techniques to assess the immunologic activity within the graft environment have been developed that could further enhance our discriminating ability. However, these sophisticated techniques are not readily available to most clinicians who are currently managing patients with graft dysfunction. This article focuses on the different methods of distinguishing rejection from cyclosporine-induced toxicity. The data were abstracted from relevant papers published in the scientific literature during the past 12 months.

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