Early Diagnosis Of Rejection Research Articles

Doppler ultrasound in the diagnosis of renal allograft rejection and in monitoring the effect of treatment

Thirty-six consecutively transplanted renal allograft patients were prospectively monitored with ultrasound-Doppler examinations three times weekly during the first 3 weeks after transplantation. Although triple-immunosuppressive therapy consisting of cyclosporin A, azathioprine and prednisolone was used, acute rejection occurred in 11 patients. Nine patients had immediate onset of graft function and no rejection. Ten patients had acute tubular necrosis (ATN) without any signs of rejection and were treated with dialysis for 1-3 weeks after transplantation. Thrombosis of the renal artery was diagnosed in four patients. During rejection episodes pulsatility index (PI) was above normal range in all patients. In patients with mild to moderate ATN the PI was normal throughout the clinical course whereas two patients with severe ATN but no signs of rejection in the kidney biopsy also had high PI. It is concluded that serial Doppler velocity examination after kidney transplantation is a non-invasive, cheap and reliable method for monitoring of the graft. The method can be used in the early diagnosis of rejection, and it is of special value in monitoring grafts without function.

Doppler ultrasound in the diagnosis of renal allograft rejection and in monitoring the effect of treatment

Thirty-six consecutively transplanted renal allograft patients were prospectively monitored with ultrasound-Doppler examinations three times weekly during the first 3 weeks after transplantation. Although triple-immunosuppressive therapy consisting of cyclosporin A, azathioprine and prednisolone was used, acute rejection occurred in 11 patients. Nine patients had immediate onset of graft function and no rejection. Ten patients had acute tubular necrosis (ATN) without any signs of rejection and were treated with dialysis for 1-3 weeks after transplantation. Thrombosis of the renal artery was diagnosed in four patients. During rejection episodes pulsatility index (PI) was above normal range in all patients. In patients with mild to moderate ATN and PI was normal throughout the clinical course whereas two patients with severe ATN but no signs of rejection in the kidney biopsy also had high PI. It is concluded that serial Doppler velocity examination after kidney transplantation is a non-invasive, cheap and reliable method for monitoring of the graft. The method can be used in the early diagnosis of rejection, and it is of special value in monitoring grafts without function.

Improvement of canine pancreas-allograft survival with diagnosis of rejection by fine-needle aspiration biopsy.

Early diagnosis of rejection in pancreas-allograft transplantation remains a clinical challenge. The aim of this study was to assess the ability of antirejection therapy to reverse rejection when the diagnosis was based on either fine-needle aspiration biopsy (FNAB) or urinary amylase (UA). Sixteen dogs received a total-pancreas allograft with exocrine drainage into the bladder. Initially, a deliberately low dose of cyclosporin was given. Monitoring included percutaneous FNAB with ultrasound guidance and fasting spot measurements of UA. The diagnosis of rejection was made in alternate dogs when UA fell to less than 5000 IU/L (group A) or when the total corrected increment (TCI) of aspirated infiltrating cells was greater than 2.6 (group B). Antirejection therapy consisted of 10 mg.kg-1.day-1 i.v. methylprednisolone for 5 days and an increased dose of cyclosporin (25 mg.kg-1.day-1). The median allograft survival was 9 days (range 8-19) in group A and 32 days (range 10-63) in group B (P = .01). A fall in UA permitted the successful reversal of rejection in only one of six grafts, whereas five of seven grafts were successfully treated when rejection diagnosis was based on FNAB. In conclusion, early diagnosis of rejection was achieved by FNAB, improving the ability of antirejection therapy to reverse pancreas-allograft rejection and prolong survival.

Serum immunoreactive interleukin 1 in renal transplant recipients. Association of raised levels with graft rejection episodes.

A solid-phase radioimmunoassay was used for monitoring serum interleukin 1 levels in 12 renal transplant recipients. From 10-fold to 20-fold elevations of interleukin 1 occurred in association with 10 of 12 graft rejection episodes. The interleukin 1 elevation preceded the clinical rejection diagnosis by an average of one day in transplant recipients with initially functioning grafts, and by two days in recipients with delayed onset of graft function. The results show that the release of interleukin 1 into the circulation is an early event in renal allograft rejection and demonstrate the potential utility of interleukin 1 antigenic assays in the early diagnosis of rejection.

Immunology of renal transplantation rejection

Recent studies into the mechanisms of graft rejection have highlighted the complexity of this response. Although current immunosuppressive treatments are crude, laboratory observations on the mechanisms of graft rejection have already led to various techniques which may assist in the early diagnosis of rejection, in the prognosis of a rejection episode, and in the development of more specific therapy to prevent and treat rejection. Already, the monitoring of T-cell subsets in blood and graft infiltrates is of considerable help. These observations may lead to the advent of more specific and subtle immunosuppressive therapy, such as the use of monoclonal antibodies directed against T-cell subsets. In the long term, the induction of states of specific unresponsiveness to the graft holds great promise, as do the development of techniques to assess adequacy of immunosuppression and to detect the presence of specific unresponsiveness.

Activity of certain enzymes in cadaver renal transplants.

Enzyme studies are valuable additional methods of investigation and may be useful in early diagnosis of rejection after cadaver kidney transplantation. The complex enzyme activity should be studied. The determination of urinary enzyme activity is of greater diagnostic importance than that in blood.