ALTERATIONS IN T LYMPHOCYTE SUBPOPULATIONS ASSOCIATED WITH RENAL ALLOGRAFT REJECTION

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Abstract
The peripheral blood OKT3 (total T), OKT4 (T helper/inducer) and OKT8 (T suppressor/cytotoxic) cells were determined by flow cytometry on 20 consecutive recipients of HLA-nonidentical cadaveric renal allografts. The absolute number of cells in all 3 populations decreased significantly posttransplantation, but no differences were found between patients experiencing rejection and those in quiescence. An OKT4/OKT8 ratio of .gtoreq. 1.7, either pretransplant or posttransplant, uniformly identified patients who subsequently experienced rejection. An OKT4/OKT8 ratio of < 1.7 did not identify patients with a low risk of rejection. Pretransplant splenectomy was performed in 6 of 7 patients who rejected despite a low ratio. Serial monitoring of the OKT4/OKT8 ratio posttransplantation determined that an increase in the ratio of .gtoreq. 0.5 was a sensitive (81%) and specific (91%) indicator of a rejection episode. Graft survival was improved in patients with a high posttransplant OKT4/OKT8 ratio. The balance of helper and suppressor cell function may be of critical importance to the fate of an allograft. The alterations in this balance can be used to assist in the clinical management of allograft recipients.