Lymphocyte monitoring as a predictor of renal allograft rejection.

The ability to predict acute renal allograft rejection episodes or infectious potentials by immunologic monitoring was studied in 15 renal transplant recipients. Specifically, total circulating erythrocyte- (E) and erythrocyte-antibody-complement (EAC) rosetting cells were serially studied for the first two months after transplantation and related to immunosuppressive therapy and rejection activity. Total circulating, E-rosetting cells (T cells) were noted to be significantly depressed if rabbit anti-human thymocyte globulin (RAHTG) was used in the immunosuppression protocol. The rate at which these T cells repopulated the circulation was measured by calculating their slope (delta total E-rosettes/delta time). Patients with acute rejection had an average slope of 3.2 +/- 0.68 compared to those without rejection, whose slope was 0.74 +/- 0.35 (p less than 0.01). The rapid repopulation of T cells occurred about 10 days before clinical parameters of rejection were evident. The incidence of infection was greater in those patients with total E-rosettes less than 200/mm3. Serial monitoring of total E-rosetting cells after transplantation provides a diagnostic tool for predicting ensuing rejections and can also be used to gain information concerning the susceptibility to infection.