Morales, J. M.1; Wramner, L.; Kreis, H.; Durand, D.; Campistol, J. M.; Andres, A.; Arenas, J.; Groth, C. G. for the Sirolimus European Renal Transplant Study Group. Author Information
The OKT series of anti-T-cell monoclonals has been used on 442 occasions in 41 renal allograft recipients in a 6-12 month follow-up study. Standard immunosuppressive therapy (including antithymocyte globulin in 26 patients) tended to decrease the helper-inducer/suppressor-cytotoxic cell ratio (OKT4/OKT8). Conversely, 71% of 35 renal failure episodes were associated with increased OKT4/OKT8 ratios. Twenty-three percent of renal failure episodes were associated with dramatically decreased OKT4/OKT8 ratios. At least half of these cases could be explained by a cytomegalovirus infection. In fact, similar infections were found in 6 out of 17 patients with low OKT4/OKT8 values in the absence of renal failure. These results prompt us to use anti-T cell monoclonals for the diagnosis of rejection because only nine episodes of transient increase in the OKT4/OKT8 ratio were observed in the absence of rejection. The interest of this new method for the immunological follow-up of transplanted patients is, however, limited by the difficulty in interpreting a significant percentage of tests because of (1) the presence of doubly labeled cells (OKT4+OKT8+) or the significant discrepancy between the number of OKT3+ cells and total cells labeled with OKT4 and/or OKT8 antibodies; (2) gross lymphocytopenia--most often observed in patients receiving antithymocyte globulins plus steroids; and (3) the clinically unexplained shifts in the T cell subset ratios mentioned above.
Infective complications are analysed in 100 transplanted patients all receiving corticosteroid and azathioprine. 170 infective episodes were noted, only 13 patients never had infection during the period of observation. Two complications were dominated by their gravity : pneumopathies (n equals 29) fatal in 20.6% of cases, and septicemia (n equals 21) fatal in 28.5% of cases. Alone they represented 75% of the overall mortality in this series. More than 50% of failures due to death or detransplantation, were directly due to infection. The results show that this type of complication represents the main limiting factor to renal grafts in patients submitted to immunosuppressor treatment which depresses non-specifically, the whole immune response.
