J. Steinmann et al., FAILURE OF IN-VITRO T-CELL ASSAYS TO PREDICT CLINICAL OUTCOME AFTER HUMAN KIDNEY-TRANSPLANTATION, Journal of clinical laboratory analysis, 8(3), 1994, pp. 157-162
Allotransplant rejection is a T-cell-dependent reaction. Functional in
vitro T-cell assays are being used widely for donor-recipient matchin
g in bone marrow transplantation and have recently been used in some c
entres for transplant monitoring. In order to assess tolerance inducti
on after clinical transplantation, we measured the T-cell response of
the host against donor spleen cells of 33 kidney transplant patients b
efore and every 3 months after transplantation over a period of 18 mon
ths. The T-cell reactivity before transplantation was not significantl
y different in any of the assays in rejecting and nonrejecting patient
s. in the classical mixed lymphocyte culture (MLC), a donor-specific l
oss of reactivity was seen only in a patient with a CMV-associated irr
eversible transplant rejection. One patient with chronic rejection acq
uired a very high MLC response against donor spleen cells and a high r
esponse against third-party cells. Little or nonspecific changes were
seen in the MLCs of all other patients. Using the method of limiting d
ilution analysis (LDA), we found a significant reduction of donor-spec
ific cytotoxic T-cell precursors (CTL-p) within the first 3 months aft
er transplantation in most patients with high antidonor CTL-p frequenc
ies before transplantation. The reduction of donor-specific CTL-p was
seen in patients with rejection episodes as well as in patients withou
t. Thus we conclude, in contrast to others, that MLC and CTL-p LDA hav
e no predictive value on the outcome of clinical transplantation. (C)
1994 Wiley-Liss, Inc.