NEW MEDICAL TECHNOLOGIES AND CLINICAL-PRACTICE - A SURVEY OF LYMPHOCYTE SUBSET MONITORING

Background: Since its inception in the early 1980s, lymphocyte subset (LS) monitoring of transplant patients has been a controversial techni que. The clinical literature is replete with contradictory claims conc erning its usefulness. No systematic information is however available on clinicians' attitudes towards the new technology. Method. We carrie d out a mail survey of the members of The Transplantation Society conc erning the availability, use, value, and critical assessment of LS mon itoring. Results. Results show that LS monitoring technology is availa ble in most clinical settings surveyed and is regularly used by about half of the respondents associated with a clinical transplant program. About half of the users obtain diagnostically relevant measurements ( T4/T8 ratios), as opposed to measurements related to OKT3 anti-rejecti on therapy. While claiming that LS measurement is a useful tool, respo ndents attribute a low average score to the diagnostic value of the te chnique; about 2/3 believe that its absence would not affect their cli nical judgment. Finally, 25% of the respondents send blood for LS meas urements although they do not believe the technique is useful. Conclus ions. The results suggest that research instruments which generate cli nical interest may develop clinical-diagnostic routines despite a lack of consensus concerning their usefulness. More importantly, these rou tines avoid a critical assessment of key notions such as ''immune moni toring'' which tend to blur the distinction between research and thera py.