Lymphocyte Monitoring as a Predictor of Renal Allograft Rejection

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Abstract
The ability to predict acute renal allograft rejection episodes or infectious potentials by immunologic monitoring was studied in 15 [human] renal transplant recipients. Specifically, total circulating erythrocyte- (E) and erythrocyte-antibody-complement (EAC) rosetting cells were serially studied for the first 2 mo. after transplantation and related to immunosuppressive therapy and rejection activity. Total circulating, E-rosetting cells (T [thymus-derived] cells) were significantly depressed if rabbit anti-human thymocyte globulin (RAHTG) was used in the immunosuppression protocol. The rate at which these T cells repopulated the circulation was measured by calculating their slope (.DELTA. total E-rosettes/.DELTA. time). Patients with acute rejection had an average slope of 3.2 .+-. 0.68 compared to those without rejection, whose slope was 0.74 .+-. 0.35 (P < 0.01). The rapid repopulation of T cells occurred about 10 days before clinical parameters of rejection were evident. The incidence of infection was greater in those patients with the total E-rosettes less than 200/mm3. Serial monitoring of total E-rosetting cells after transplantation provides a diagnostic tool for predicting ensuing rejections and can also be used to gain information concerning the susceptibility to infection.