T and B cell patterns in irreversibly rejected human renal allografts. Correlation of morphology with surface markers and cytotoxic capacity of the isolated lymphoid infiltrates.

To define the composition and proliferative and functional activity of the rejection formed sheep erythrocyte rosettes (T cells), expressed surface Ig (B cells) or Fc receptors and specific lymphocyte-mediated cytotoxic activity. Small clumped lymphocytes (48.8 +/- 18.9 per cent) and plasma cells (18.8 +/- 10.9 per cent) were most common and correlated negatively (p less than 0.01). Percentages of surface Ig-bearing and small clumped lymphocytes correlated directly (p less than 0.05) as did the percentages of E rosette-forming and plasma cells (p less than 0.05). The percentages of surface Ig-bearing B cells correlated negatively with E rosette-forming T cells (p less than 0.05). Within this spectrum of rejection, three patterns could be identified. In the first pattern, humoral rejection (by immunofluorescence) was intense and cellular infiltration was primarily by surface Ig and Fc receptor-positive small clumped B lymphocytes. The second and most common pattern consisted of a mixed T and B cell infiltrate with intermediate to high lymphocyte-mediated cytotoxic activity and variable humoral rejection. In the third pattern, invitro studies showed primarily E rosette-forming T cells with paradoxically low lymphocyte-mediated cytotoxic activity. However, morphologic studies also revealed the highest percentages of plasma cells but only mild humoral rejection. Thus, combined morphologic and in vitro studies identified three patterns of protracted renal allograft rejection. Thus, combined morphologic and in vitro studies identified three patterns of protracted renal allograft rejection for which the percentages of plasma cells may provide a distinguishing morphologic marker. Furthermore, the degree of lymphocytic invasion of renal tubules and blood vessels may provide an estimate of lymphocyte-mediated cytotoxic activity.