Analysis of the inflammatory leucocyte mobilization in 838 fine needle aspiration biopsies in non-rejecting (day 1–90) kidney grafts and 465 biopsies in grafts before, during and after acute cellular rejection

Abstract

A total of 1303 fine needle aspiration biopsies (FNABs) were performed in all 105 kidney transplanted patients at our institution during 1990–1992: 838 were in patients who never had an acute cellular rejection (ACR), and 465 were in patients who had experienced an ACR; 393 of these FNABs were performed in first rejections and 72 in second rejections. The immunosuppressive protocol included monotherapy with cyclosporin A and an initial, additional course of Minnesota-ALG during the first ten days after transplantation (Tx). OKT3 was first-line antirejection therapy accompanied for a short period with prednisolone and azathioprine to oppose the development of anti-OKT3 antibodies. FNABs were taken each day for the first three days after Tx, then twice a week for the first month, and then at each visit to the outpatient clinic for the next three months. In non-rejecting grafts the total corrected increment (median) of the inflammatory response (TCI) increased from 1 to a maximum of 3.5, 17–21 days after Tx followed by a slight decrease. The inflammatory response was mainly due to non-activated lymphocytes. In the rejecting grafts the TCI (median) increased from three days before ACR to a maximum of 7 on the day of ACR, followed by a decrease when OKT3 treatment was started. The infiltrating cells were activated lymphocytes, other lymphocytes and, in smaller amounts, macrophages and monocytes.