Immuno-monitoring After Human Bi-forearm Transplantation

Aims To discuss the invasion immunomonitoring indexes which can predict arid diagnose rejection before it occurs, to direct the use of immunosuppresive drugs and predict opportunistic infection, tumor and graft versus host disease, according to evaluating of the immune state, we do the following researches. Materials and methods We collect peripherial blood of the first patient in Asia receiving bi-forearm allotransplantation from Sep. 2000 to Dec, 2000. By using flow cytometry (FCM) and ensyme linked immunosorbent assays (ELISA), we detect the variety of cluster of differentiation of T lymphocytes, IL-2, IL-6 and soluble IL-2 receptor in serum. Results The outcomes show that Ihe percentages of CD3+, CD4+, CD8+T lymphocyte, IL-2 recptor (CD25), cytotoxic I cell (CD8+CD28+), Suppressor T cell (CD8+C028+), silent I lymphcyte (CD3+/HLADR-, CD3+/CD16+56-); T cell activated (CD3+/HLADR+), adhesion molecule(CD28,CD54,CDI 1 a) decreased significantly during the inducing period, while B cells activated(CD3+/HLADR+), NK cells (CD3-/HLA 16+56+) increased. CD8+ T lymphocytes, suppressor T cells, activated T cells increased constantly, while cytotoxic cells maintain low level during maintaining period.The ratio of CD4/CD8 decreased constanly after transplantation. Actived B cells, NK cells, adhesion molecule regain subsequently the pretransplantion level. The serum levels of IL-2, IL-6 and sIL-2R decreased quickly during inducing period then increased gradually. The level of IL-2 was lower than the pretransplantion level, while the level of IL-6 and sLL-2R was slightly higher than the pretransplantion level. Conclusion 1. The use of immunosuppressive agents after limb transplantation especially large doses of Methylprednisolone and antithymocyte globulin can strongly suppress the expression of cluster of differentiation, maintain the CD3+ lymphocytes; lL-2~ IL-6 slL-2R at lower level which effectively suppress the activation of I lymphocytes during the first week after bi-forearm allotransplantation. 2. Monitoring cluster of differentiation of I cell and the serum levels of IL-2.. lL-6.. sIL-2R may be useful for predicting and diagnosing rejection, evaluating the survival of graft. 3. Monitoring cluster of differentiation of I cell and the serum levels of IL-2~ IL-6., sIL-2R are useful for modulating the doses of the immunosuppressive agents and preventing adverse effects. 4. In this patient the daily dose of ATG (1 .25mg/kg/d) maintain the level of CD3+ I cells at 0.1-0.3 X 109/L, which is lower than that(2mglkg/d) of single hand transplantation. So the dose of ATG should be individualized with immunology monitoring. 5. Each tissue component of limb displays different antigen expression and presentation mechanisms, however the intensity of immunologic reaction wasn't huger than we thought before. We shuold discuss more about mechanism.