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.