Cytoimmunological monitoring in acute rejection and viral, bacterial or fungal infection following transplantation.

This study assessed the ability of immunomonitoring to differentiate between acute cardiac rejection and viral, bacterial or fungal infections, using data of thirty-five cyclosporine treated heart and heart-lung transplant recipients. Peripheral blood samples were analyzed daily for 20 days, then three times weekly until the patient's discharge. Later, peripheral blood was examined every fourteen days on an outpatient basis. White blood cells were counted and differentiated. A mononuclear concentrate was obtained by the Ficoll-Hypaque gradient and centrifugation method, and cytocentrifuged onto slides. The cells were stained by a five minute method. Percentages of lymphocytes, prelymphoblasts, lymphoblasts, large granular lymphocytes and monocytes were calculated. When activated cells were detected, aliquots of the mononuclear concentrate were labeled using monoclonal antibodies. In these thirty-five patients, more than 60 acute rejection episodes were diagnosed by the cytoimmunological method. Acute rejection was characterized by a significant rise of the number of leukocytes, lymphocytes, prelymphoblasts and lymphoblasts. The T-lymphocyte population increased while the B-cells remained normal. Ninety-five percent of all acute rejection episodes were diagnosed using cytoimmunological parameters. During viral infection more than 20% of the mononuclear cells were large granular lymphocytes and the OKT4/OKT8 ratio was less than one. During bacterial and fungal infections the B-lymphocytes increased to 40% of the mononuclear cells. In addition, juvenile polymorphs appeared in the mononuclear concentrate and the OKT4/OKT8 ratio was within normal limits (1.5 to 2.5).(ABSTRACT TRUNCATED AT 250 WORDS)