Anti-Donor Immune Responses in Prediction of Transplant Rejection

Abstract

We assessed various immune responses against donor tissue to determine their value in the diagnosis and prediction of clinical rejection episodes. Twenty-six consecutive clinical renal-transplant recipients were examined. Cell-mediated lymphocytotoxicity preceded and accompanied 41 of 45 rejection episodes (P<0.001). Complement-dependent antibody was present in 12 of 15 rejections (P<0.002) — four not accompanied by, and eight in association with, cell-mediated lymphocytotoxicity. Mixed lymphocyte reactivity or nonreactivity and inhibition by autologous serum occurred equally often in rejection and quiescence. Lymphocyte-dependent antibody occurred during both rejection episodes and quiescent phases, with a greater frequency during quiescence (P=0.05). Cell-mediated lymphocytotoxicity was the best predictor of rejection (P<0.001), and was more easily suppressed by standard immunosuppressive therapy, than complement-dependent antibody. If specific cell-mediated lymphocytotoxiclty, with or without antibody, recurred after rejection therapy, the graft underwent further rejection (P<0.01). (N Engl J Med 294:978–982, 1976)