Early Prediction of Acute Homograft Rejection: Urinary Assay for Polyribosomal-rich Lymphocytes

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Abstract
Urinary cytology from 29 pediatric renal homograft recipients was evaluated for the presence of polyribosomal-rich (pyroninophilic) lymphocytes during an 8 mo. period. Seven episodes of acute (cell-mediated) rejection occurred in 21 cadaveric renal recipients. No episodes of rejection occurred during this period in the living-related recipients. Each episode of rejection was associated with significant polyribosomal-rich lymphocyturia 5-11 days before the onset of clinical rejection as diagnosed by conventional methodology. Significant lymphocyturia occurred 1-3 days before and simultaneous with a sustained elevation in serum creatinine. Falsely positive assays demonstrating occasional to 1 plus (less than 10%) ribosomal-rich lymphocyturia occurred in 10 of 29 patients. None of these falsely positive-reacting patients demonstrated acute rejection. The urinary assay for polyribosomal-rich lymphocytes was an early indicator of acute rejection. By early institution of antirejection therapy (based on this parameter), homograft rejection may be aborted or its severity diminished.