Massive elevation of procalcitonin plasma levels in the absence of infection in kidney transplant patients treated with pan-T-cell antibodies.
OBJECTIVE
To determine the value of procalcitonin (PCT) monitoring in transplant patients receiving pan-T-cell antibody therapy.


METHODS
Retrospective clinical study.


METHODS
A collaborative study between the Institute of Medical Immunology, the Department of Nephrology and Internal Intensive Care, both Charite, Humboldt University Berlin, and the Department of Laboratory Medicine, Friedrichshain Hospital, Berlin, Germany.


METHODS
Thirty-one patients were included in the study: 8 kidney transplant patients with acute rejection episodes, 5 receiving OKT3 monoclonal antibody therapy, 3 receiving steroid bolus therapy; 21 patients undergoing renal transplantation, 11 receiving ATG perioperatively, 10 without ATG administration; 2 patients undergoing renal transplantation and receiving anti-IL-2R mAb.


RESULTS
Procalcitonin (PCT) and tumor necrosis factor (TNF) alpha plasma levels were measured in infection-free transplant patients treated with the pan-T-cell antibodies ATG or OKT3. We found PCT plasma concentrations up to 600 ng/ml (reference < 0.5 ng/ ml), which are comparable to those seen in severe sepsis. Increases in TNF-alpha plasma levels preceded the rises in PCT. After peaking on day 1 of therapy the PCT plasma concentrations returned to normal values independently of further antibody administration. In contrast, steroid bolus therapy or anti-interleukin 2 receptor mAb administration did not increase plasma PCT or TNF-alpha levels.


CONCLUSIONS
PCT monitoring for evaluating infectious complications in kidney transplant patients must be very careful during pan-T-cell antibody therapy.
Sabat
R
R
Institute of Medical Immunology, Charité, Humboldt University Berlin, Germany.
Höflich
C
C
Döcke
W D
WD
Oppert
M
M
Kern
F
F
Windrich
B
B
Rosenberger
C
C
Kaden
J
J
Volk
H D
HD
Reinke
P
P
D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation; D016853:Muromonab-CD3 / Q000627:therapeutic use*; D011498:Protein Precursors / Q000097:blood*; D012189:Retrospective Studies; D013601:T-Lymphocytes / Q000276:immunology*; D014409:Tumor Necrosis Factor-alpha / Q000096:biosynthesis
D000961:Antilymphocyte Serum; C000606589:CALCA protein, human; D007166:Immunosuppressive Agents; D016853:Muromonab-CD3; D011498:Protein Precursors; D014409:Tumor Necrosis Factor-alpha; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide