Soluble interleukin-2 receptor (sIL-2R) levels in renal transplantation: comparison between clinical and laboratory analysis.
Soluble interleukin-2 receptor levels (sIL-2R) were retrospectively evaluated in 43 consecutive kidney transplant recipients (22 males, 21 females), from day 0 up to 90 days after transplantation. 11 pts were on CsA only, 13 on CsA + MP and 19 on CsA + MP + Aza. All graft-worsening episodes were then retrospectively analyzed, either according to clinical criteria only, or taking into account sIL-2R levels. On clinical grounds, 50 rejections were observed: "a posteriori" 5 turned out to be either infections or non-immunological worsenings of graft function (prevalence of misdiagnosis in the rejection set: 5/50, 10%). Of the 8 infections, 2 were actually treated as rejections (margin of error: 2/8, 25%). CsA toxicity was correctly diagnosed in 2/4 episodes. The analysis based on sIL-2R levels increase confirmed the clinical diagnosis in 52/79 cases (66%). The prevalence of misdiagnosis was: 21.2% in rejection, 2/3 in CsA toxicity, while infections were overestimated in 60% of cases. Isolated sIL-2R level increase was not associated with rejection in 87.5% of cases, while an associated increase of IL-2R and plasma creatinine had a 5% chance of being wrong. SIL-2R levels increased before any rise in plasma creatinine in late rejections (28 +/- 21 days after transplantation), while they increased after the rise of plasma creatinine in early rejections (10 +/- 5 days) (p = 0.014). In the rejection set, sIL-2R had a sensitivity of 83.4%, a specificity of 80%, a positive predictive value of 50.2% and a negative predictive value of 95.2%.(ABSTRACT TRUNCATED AT 250 WORDS)
Montagnino
G
G
Division of Nephrology, Ospedale Maggiore, Milan, Italy.
Tarantino
A
A
Grignani
S
S
Braga
M
M
Ponticelli
C
C
D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000097:blood / Q000175:diagnosis; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006084:Graft Rejection / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015375:Receptors, Interleukin-2 / Q000032:analysis*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D015375:Receptors, Interleukin-2; D016572:Cyclosporine; D003404:Creatinine; D001379:Azathioprine; D008775:Methylprednisolone