Background: Acute rejection with its chronic sequel may affect the overall outcome of renal Tx. It is a complex series of events involving the cytokine response, signaling the initiation and modulation of this process.
Objectives: Our aim was the early detection and managements of rejection and preservation of graft function.
Methods: 7 children and 18 adult transplanted cases were followed 1, 3 and 6 months after Tx by monitoring several cytokines including Tumor Necrosis Factor alpha (TNF-α), IL-1, IL-3, IL-4, IL-10, transforming Growth Factor Beta (TGF-β), Insulin Like Growth Factor I (IGF-1) and Platelet Derived Growth Factor (PDGF-AB) as well as estimation of the T-helper (T4) to the T-suppressor (T8) ratio. Fifteen of the 25 cases had an impairment of their graft function at one time of the follow up period. The results were compared with the values of 10 healthy controls.
Results: The 10 stable cases included 5 children whose cytokine levels were no significantly different from those of the 5 adults. The mean values of the 15 cases with dysfunction were significantly higher than those of the 10 stable cases and 10 controls. There were significant positive correlation between the s. creatinine and all the studied parameters except IGF-1 whose rate of decline rather than its absolute levels which correlated with the s.creatinine. Five/15 cases with dysfunction were already presenting with renal impairment by the time of the first sampling. In the remaining 10/15 prediction prior to acute dysfunction was achieved in all of them, denoting 100% predictability. Of these TNF-α predictability. Of these TNF-α predicted 8/10, IL-4 6/10, IL-10 6/10, IL-3 3/10, and IL-1 2/10.
Conclusions: More frequent monitoring of various cytokines may increase the predictability values, and it may be limited to monitoring of TNF-α, IL-4 and/or IL-10. The value of monitoring TGF-β, IGF-1 and PDGF-AB may be more valuable later in transplantation.