Mehta Rajil, Shah Gaurang, Adler William, Kittur Dilip
Department of Medicine, Division of Nephrology, SUNY Upstate Medical University, Syracuse, NY 13210, USA.
Clin Transplant. 2004;18 Suppl 12:67-71. doi: 10.1111/j.1399-0012.2004.00221.x.
Allograft rejection is associated with T cell activation. T cell activation leads to secretion of soluble IL-2 receptor and elevated serum soluble IL-2 receptor (sIL-2R) levels. However, the clinical implication of individual elevated sIL-2 receptor levels is unclear. We followed levels of sIL-2R pre- and post-transplantation to determine if sIL-2R levels predict rejection episodes or degree of graft function.
Serum samples of 12 patients who underwent living or cadaveric renal transplant were followed weekly with serial sIL-2R levels. These levels were followed until the serum creatinine reached a baseline. Of the 12 patients, three patients developed delayed graft function. The remaining nine patients were followed for a period of 3 months. Sera of these nine patients in the initial 3 months post-transplant were monitored for sIL-2R levels. For comparison, sIL-2R levels were also measured in 150 healthy volunteers and five dialysis patients.
Recipients undergoing severe rejection episodes had higher overall serum levels of sIL-2R (1515 +/- 496 U/mL) as compared with recipients who had stable renal transplants and no episodes of rejection (698 +/- 333 U/mL) (P = 0.034). Comparison of sIL-2R ratios (post-transplant sIL-2R level/pre-transplant sIL-2R level) revealed that ratios of 0.6 or higher were more frequently seen in patients who subsequently underwent severe rejection episodes. Dialysis patients were found to have higher sIL-2R levels (2605 +/- 1312 U/mL) compared with renal transplant patients (1047 +/- 192 U/mL) (P < 0.001) and healthy volunteers (349 +/- 185 U/mL) (P < 0.001).
Our results suggest that individual levels of sIL-2R are not predictive of rejection in the early post-transplant period, but s-IL2R ratios greater than 0.6 may be predictive of severe rejection episodes.
同种异体移植排斥反应与T细胞活化有关。T细胞活化导致可溶性白细胞介素-2受体分泌增加以及血清可溶性白细胞介素-2受体（sIL-2R）水平升高。然而，个体sIL-2受体水平升高的临床意义尚不清楚。我们追踪了移植前后sIL-2R的水平，以确定sIL-2R水平是否能预测排斥反应发作或移植肾功能程度。
对12例行活体或尸体肾移植患者的血清样本每周进行连续sIL-2R水平检测。这些水平一直追踪到血清肌酐达到基线。12例患者中，3例发生移植肾功能延迟恢复。其余9例患者随访3个月。对这9例患者移植后最初3个月的血清进行sIL-2R水平监测。作为对照，还检测了150名健康志愿者和5名透析患者的sIL-2R水平。
与移植肾功能稳定且无排斥反应发作的受者相比，发生严重排斥反应发作的受者血清sIL-2R总体水平更高（1515±496 U/mL对698±333 U/mL）（P = 0.034）。sIL-2R比值（移植后sIL-2R水平/移植前sIL-2R水平）比较显示，随后发生严重排斥反应发作的患者中，比值为0.6或更高更为常见。发现透析患者的sIL-2R水平（2605±1312 U/mL）高于肾移植患者（1047±192 U/mL）（P < 0.001）和健康志愿者（349±185 U/mL）（P < 0.001）。
我们的结果表明，个体sIL-2R水平在移植后早期不能预测排斥反应，但sIL-2R比值大于0.6可能预测严重排斥反应发作。
