신장이식후 급성 거부반응의 조기 진단검사로서 IL-2,IL2R,IL-6 및 TNF-a의 의의

Abstract

In order to avoid unnecessarily heavy immunosuppression and the complications due to misdiagnosing acute rejection, we checked the serial serum cytokine levels in 34 living renal transplant recipients (excluding pediatric recipients, cadaver donor grafts and one acute vascular rejection which was removed on the 7th post-transplant day) operated on between January 1994 and June 1995, and we analyzed the relation between the cytokine levels in these cases and acute rejection. Among the 34 recipients, 11 developed acute rejection within one month after transplantation, 8 of them being confirmed by renal biopsy; however, all of these recipients showed excellent initial graft function. The elevation of the cytokine levels, except IL-6, started from 1-3 days before either clinical suspicion of rejection or increase of serum creatinine levels. Postoperative levels of IL-2, IL-2R, and TNF- were significantly higher in the rejection group than in the non-rejection group, and these findings continued at least until the 15th post-transplant day. The group whose rejection episodes developed within 2 weeks after transplantation showed higher cytokine levels, except IL-6, than those of the group whose rejection episodes occurred after 2 weeks (P<0.05). These elevated cytokine levels returned to pre-rejection levels in the group who responded to anti-rejection therapy, but maintained higher levels in the no-response group (P<0.05). In summary, these results suggest that during the early post-transplant period, the serial checking of serum cytokine levels can both predict the onset of acute rejection earlier than the conventional method and tell us the status of the response to anti-rejection therapy. However, the absolute significance of the cytokine levels and the cost of daily laboratory test for cytokine should also be considered.