T-cell immune defect and B-cell activation in renal transplant recipients with monoclonal gammopathies

Monoclonal immunoglobulins (molg) have repeatedly been described in organ a nd bone narrow transplantation. Although their exact significance is not kn own, their occurence is often associated with intensive immunosuppression. We investigated whether molg reflect T-cell immune defect and B-cell activa tion in renal transplant recipients. Immunofixations and lymphocyte subset analysis (CD4, CD8, CD19) were performed in 182 renal transplant recipients . Soluble CD23 concentrations were measured in patients with molg and in co ntrol transplant patients without molg. Monoclonal immunoglobulins were ide ntified in 54 patients (29.6 %). Transplant endurance was shorter (62 +/- 5 3 months vs 81 +/- 47 months; P < 0.02) and age was older (53 +/- 13 years vs 46 +/- 13 years; P < 0.005) in patients with molg. Maintenance immunosup pression did not differ between patients with and without molg. Mean CD4-ce ll count was significantly lower in patients with molg (387 +/- 286/mm(3) v s 538 +/- 341/mm(3); P < 0.005). Both CD8- and mm CD19-cell counts were sim ilar for the 2 groups. Soluble CD23 concentrations were higher in patients with abnormal immunoglobulin values than in patients with normal immunofixa tion (12.8 +/- 8 vs 1.9 +/- 1 1.8 mu g/l; P < 0.005). Our study provides ne w evidence that molg reflect T-cell immune defect in renal transplant recip ients. Further studies are required to determine whether CD4-cell count and sCD23 may help to predict the risk of lymphoma in transplant patients with molg.