Influence of pretransplant dialysis modality on the change of lymphocyte subset populations and acute rejection rates after renal transplantation.
BACKGROUND
The influence of dialysis modality on the acute rejection (AR) rate after renal transplantation is controversial. We investigated whether the pretransplant dialysis modality correlated with the lymphocyte subset populations and the incidence of AR after renal transplantation.


METHODS
Thirty-eight first living renal transplant recipients, consisting of 22 patients on pretransplant hemodialysis (HD) and 16 patients on pretransplant peritoneal dialysis (PD), were studied. Peripheral blood samples were taken on days -1 through 28 after transplantation, and the lymphocyte fractions were exposed to the monoclonal antibodies anti-CD3, CD19, CD4, CD8 and CD28 for a flow cytometer analysis. Biopsy specimens were obtained at the time of presumed AR episodes and on day 28 after transplantation.


RESULTS
The PD patients had a higher frequency of AR (37.5% in PD vs 9.1% in HD patients, P = 0.034). In contrast, two HD patients showed graft loss at 18 and 30 months after transplantation. The increases of CD3, CD19, CD4 and CD4+ CD28+ cells in the PD patients occurred earlier than in the HD patients and the numbers of these cells in the PD group were higher than those in the HD between days 3-28 after transplantation, most significantly on day 7.


CONCLUSIONS
These findings suggest that the PD patients with similar clinical characteristics could potentially have a higher immunocompetence and immune responsiveness associated with a higher rate of AR in the early stage of renal transplantation when compared with the HD patients.
Department of Urology, Akita School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan. shigerus@doc.med.akita-u.ac.jp
Shigeru
S
Satoh
Norihiko
N
Tsuchiya
Kazunari
K
Sato
Hiroshi
H
Ohtani
Atsushi
A
Komatsuda
Tomonori
T
Habuchi
Tetsuro
T
Kato
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006084:Graft Rejection / Q000097:blood* / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D016030:Kidney Transplantation; D016131:Lymphocyte Subsets; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D006435:Renal Dialysis / Q000379:methods*; D012307:Risk Factors