Pretransplant mixed lymphocyte culture still has an impact on graft survival.
OBJECTIVE
Mixed lymphocyte culture (MLC) is an important in vitro test for studying allograft reaction. The recipient-donor MLC reflects donor specific hypo- or hyperimmune response. The various studies have been correlated donor-specific MLC reactivity with graft survival in cadaver kidney transplantation. This retrospective study reports the relationship between of MLC hyper-responsiveness and graft survival in living-donor kidney transplantation.


METHODS
The study included 477 patients who underwent live-donor kidney transplantation between Marsh 1976 and January 2002. They were divided according to the relative response (RR) of pre transplant one way MLC into hypo responders (RR <4) and hyper responders (RR >4). The demographic and follow-up data for both groups were recorded. The duration of follow-up ranged from 44 to 84 months.


RESULTS
The two groups were homogeneous regarding age, sex, donor source, HLA-A, B-and -DR mismatches, number of blood transfusion and type of 3 primary immunosuppressions. Acute rejection (AR) episodes were seen in 182 (44.8%) patients in the hypo-responders group, of whom 10 were steroid resistant, while in the hyper-responder recipients, AR episodes occurred in 33 patients (46.5%) of whom 5 patients (15.2%) were steroid resistant (p < 0.05). Chronic allograft nephropathy occurred in 14.5% and 27.3% and the actuarial 5-year graft survival was 79% and 60% (p = 0.03).in the hypo- and hyper-responder groups, respectively.


CONCLUSIONS
It is concluded that MLC reaction may predict high-risk patients for immunological graft failure and that more potent immunosuppression should be considered in MLC hyper-responders.
El-Agroudy
Amgad E
AE
Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. amgadelbaz@ahram0505.net
Ismail
Amani M
AM
El-Chenawy
Farha A
FA
Shehab El-Din
Ahmed B
AB
Ghoneim
Mohamed A
MA
D000328:Adult; D002478:Cells, Cultured; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D008214:Lymphocytes; D008297:Male; D011300:Preoperative Care; D012189:Retrospective Studies