Application Of HLA â…  And PCT In Diagnosis Of Acute Rejection Or Infection After Renal Transplantation

BACKGROUND:With the rapid development of organ transplantation technique, kidney transplantation has become the most effective means to the treatment of end-stage renal disease. But acute rejection after transplantation remains the major postoperative complication, also the most important risk factor to chronic rejection and graft dysfunction. In addition,the infection after renal transplantation is also the important cause for death. There has been no a good indicator can reliably and accurately reflect the early rejection, and differentiate between rejection from infection effectively. Then scholars from various countries are trying to find non-invasive or minimally invasive, low invasive diagnosis to differentiate between rejection and infection. Especially the study of peripheral blood for the information of rejection increasingly received more attention at home and abroad.OBJECTIVE:Study has found that human leukocyte antigen-Ⅰ (HLA-Ⅰ) expression levels on peripheral blood lymphocytes could reflect the patient’s immunologic function status.The level of HLA-Ⅰ on peripheral blood lymphocytes increases significantly in patients with acute renal allograft rejection, which can be used as a good indicator for diagnosis of acute rejection. Based on an dynamic monitoring of the HLA-Ⅰ on peripheral lymphocytes and serum procalcitonin (PCT) levels, we investigated its relationship with acute rejection and infection after renal transplantation, in order to provide laboratory evidence for differential diagnosis of the acute rejection and infection after renal transplantation. METHODS:Ninety-nine renal transplant recipients(102cases) were divided into3groups, according to clinical symptoms, renal function examination, imaging and renal allograft biopsy after transplantation. There were18cases in acute rejection group,14cases in infection group and70cases in post-transplantation normal group. Twenty healthy blood donors in Qilu hospital were selected as control group. The level of HLA-Ⅰ on peripheral lymphocytes was detected by flow cytometry (FCM) and the level of PCT in serum was detected by immunofluorescence.RESULTS:The HLA-Ⅰ on peripheral blood lymphocytes level in post-transplantation normal group was higher than normal level before renal transplantation and decreased step by step with the recovery of renal function; the HLA-Ⅰ level in acute rejection group was significantly increased when rejection happened compared to control group (p<0.05); the same happened in the infection group; the level of HLA-Ⅰ had no significant statistical difference between acute rejection group and infection group (p>0.05).The positive number of serum PCT in the recipients rose after renal transplantation,and the positive rate decreased to5%step by step with the recovery of renal function. There was significant statistical difference between the bacterial infection group and the other3groups (p<0.05), and no significant statistical difference was detected among other3groups (p>0.05).CONCLUSION:The level of PCT can provide effective laboratory evidence for the diagnosis of severe bacterial infection or sepsis, differential diagnosis of bacterial infection and acute rejection and the progress of disease and of good value in the judgments of therapeutic effect and progress. Besides, the level of HLA-Ⅰ in peripheral blood lymphocytes is an non-invasive objective indicator for monitoring adverse events after renal transplantation with great sensitivity. Monitoring the level of HLA-Ⅰ dynamically is an important indicator for the prediction of the acute rejection and infection.