The Diagnostic Value of Protein Clearances in Rejection of Human Renal Allografts

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Abstract
The relative clearances of transferrin, haptoglobin, Ig[immunoglobulin]G and IgA were used as a diagnostic test for detection of acute rejection episodes after renal transplantation, using an automated immunoprecipitin reaction. Of 40 rejections, 36 were predicted by 0-5 days. The sensitivity and specificity were 90 and 98%, respectively. The predictive value of a positive diagnostic test was 86% and of a negative, 99%. False positives caused by fever and urinary obstruction could probably be excluded by the finding of an increased urinary excretion of .beta.2-microglobulin prior to the increased relative clearance of transferrin, haptoglobin, IgG and IgA. This would improve the predictive value of a positive test to 95%. Daily or more frequent protein clearance determinations should be performed in renal transplant patients, since the method used was easy, rapid and suited for sequential analysis, and the procedure was without risk for the patient.