Immuno-monitoring After Human Hand Transplantation

Allotransplantation of limb has been explored in many experimental models and clinical cases recently. The immunologic challenge in a limb allotransplant is intense because of the multiple and highly antigenic tissue types (skin, muscle, bone, bone marrow, blood vessels, nerves, and articular cartilage) that comprise the limb. The clinical use of composite tissue allografts is also limited by the need for long-term systemic immunosuppression. Comparing to solid organ allografts , the inimuonological mechanism of limb allograft rejection is more complicated with presence of specific diagnostic criteria and acute predicted indictor of rejection. The doses of immunosuppressive agents that maintain solid organ allografts may fall to protect limb allografts. The augmented immunosuppression that would control graft rejection could lead to a rise in opportunistic infections, drug toxicity, and malignancies. Iimmunomonitoring after human hand allotransplantation must be essential to be performed for accurate diagnosis of the rejection process and allograft survival and regulating the dose of The immunosuppressive agent according to recipient's immune status. Part one: Determination of lymphocyte subsets in The peripheral blood of The patients wiTh hand transplantation. The activated lymphocyte populations in peripheral blood of the patients with hand transplantation were detected by using flow cytometry (FCM) from Sep ,1999 to Nov, 1999. The Results showed that the levels of CD3 , CD4, CD5, CD25 + T-lymphocyte , the activated T-lymphocyte [CD3/CD(t6+56) ,CDVHLA-DR], the silent T-lymphocyte [CD3/CD(16+567 CD3 / HLA-DA] in the patients decreased significantly during the first posttransplant week and then increased gradually to the pretransplant level except of The level of CD8 T-lymphocyte which increased to the level higher. The posttransplant CD4 / CD3 ratio decreased constantly ; B- lymphocyte (CD3 7HLA-DR~) increased during the posttransplant 10 days and subsequently decrease gradually to the level slightly higher than the pretransplant level ; Nature kill cell (CD3iCD(t6+56)) increased significantly at the first posttransplant day and then decreased quickly and maintained the low level. Part Two: Dynamic Observation of serum cytokines in The patients wiTh hand transplantation. The serum levels of IL-2, IL- 10, TNF- a, and IFN- i?in 2 hand transplant recipients were measured by enzyme linked inununosobent assays (ELISA). The results showed that the serum levels of IL-2, TNF- a , and IFN- y in the patients decreased significantly during the first posttransplant week, then increased gradually to the pretransplant levels and subsequently decreased and maintained the low levels; The serum level of IL-b in the patients increased significantly during the first posttransplant week , then decreased gradually maintained the low level. At 5 posttransplant months The serum level of IL- 10 increased moderately again. Conclusion 1. The immunosuppressive agents have significantly effects on the T-cell subsets and cytokine balance in the patients. 2. The dynamic determination of Lymphocyte subsets and serum cytokines(IL-2, IL-b, TNF- a, and lEN- y ) levels is helpful to The diagnosis of rejection and survival in hand transplantation. 3. The table?status of Lymphocyte subsets and predominance of Th2 over Thl confirmed the efficiency of immunosuppressive drug regime...