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Factors Affecting Pretransplant CD4+ Cell Response Type In Kidney Allograft Recipients

1Medhat Zaki, 1Mohamed Sherif, 1Mustafa El-Mishad, 2Ahmed A. Hassan, 3Iman Gawish, and 4Rasha Khalil.

1Department of Microbiology & Immunology, Al-Azhar University Faculty of Medicine, Cairo, Egypt. 2Department of Internal Medicine & Nephrology, Zagazig University Hospital, Zagazig, Egypt. 3Department of Clinical Pathology, National Liver Institute, Menofia, Egypt. 4Immunogenetics and Transplantation Lab, Ain Shams University Specialized Hospital, Cairo, Egypt.

Allograft rejection is probably associated with enhanced Th1 activity and tolerance with enhanced Th2. Th1 dependent effector mechanisms, such as delayed-type-hypersensitivity and cytotoxic T lymphocyte activity, play a central role in acute graft rejection. In this work we demonstrate that some recipient clinical data can influence pretransplant CD4+ cell response type. We conducted this study on thirty prospective kidney transplant recipients. Beside routine pretransplant investigations, they were assessed for their pre-transplant T-helper response type to donor-specific allostimulation. Twenty age and sex matched apparently healthy blood donors were enrolled into the study as a control group. Our results showed that in the control group [Group III], 23.7 3.4 % and 2.3 0.2 % (mean SEM) of their peripheral lymphocytes were IFN-g+ CD4+ and IL-4+ CD4+ respectively. Thirteen of the recipients (43 %) had predominant type 1 response, with 19.31 2.03 % of their lymphocytes CD4+ IFN-g+ and 2.1 0.12 % CD4+ IL-4+ [Group I]. Seventeen of them (57 %) had exaggerated type 2 with relatively impaired type 1 response, with 12.68 0.9 % CD4+ IFN-g+ and 11.86 0.9 % CD4+ IL-4+ [Group II]. Groups I & II had a statistically significant difference in Th1/Th2 ratio (P < 0.05). Nine of the 18 male patients (50 %) were among group II compared to 8 of the 12 female patients (67 %). One of 2 patients who has never been dialyzed, 8 of 15 maintained on hemodialysis for a year or less (53 %), and 8 of 13 maintained for more than one year (62 %) were among group II (P = 0.04). Two of 5 patients (40 %) who have never been transfused, 8 of 15 (53 %) who had 1-5 transfusions, and 7 out of 10 who had more than 5 transfusions (70 %) were among group II (P = 0.02, r =0.76). sixteen of the HCV antibody (HCV Ab) positive cases (57 %) (P = 0.04) and all 4 cases positive for HBs antigen were among group II. In conclusion, we found type 2 response to be associated with some factors known to induce allosensitization such as hemodialysis for more than one year, blood transfusion for more than five times, and seropositivity for HCV Ab.