Clinical Utility Of Monitoring Sialyl Lewis(X) (CD15S) Antigen On Peripheral Lymphocytes For The Diagnosis And Treatment Of Rejection After Renal Transplantation.

Objective: In organ transplantation, the grafts must be carefully monitored, but it is often difficult to make a quick and accurate diagnosis of unusual changes. Extensive research has failed to identify a useful marker for rejection. We investigated the clinical utility of sialyl Lewis(X) (CD15s) monitoring in 40 renal transplant patients including 10 patients with acute rejection.The aim of our study is to check the technique to detect CD15s on peripheral lymphocytes and know the significance of CD15s in the diagnosis of acute rejection after renal transplantation.At the same time,want to know whether it`s a factor that can be helpful for the rejection diagnosis and the estimation of anti-rejection effect. Method: 40 patients selected from renal transplant recipients were designed in to 3 groups: 20 patients with normal renal function and without rejection(A group) ; 10 patients with acute rejection (B group) within 3~6 months after renal transplantation; 10 recipients with elevated serum creatinine but without rejection(C group) ,including ATN(n=4),recipients infected with cytomegalovirus (n=2),recipients with other diseases (n=4); 10 healthy volunteers (normal control group,D group). The expression of CD15s,CD54,HLA-DR on peripheral lymphocytes was analyzed by flow cytometry, CD15s expression was compared with normal control group, and was also examined before and after acute rejection to investigate the change of CD15s antigen expression on the surface of the peripheral lymphocytes. Results: The expression of CD15s in stable group (A group) increased and changed moderatly after reducing,but there were no significant differences when compared with the C group; The expression of CD15s increased significantly during the rejective time (P<0.01),and reduced immediately after immunosuppressive agent (such as MP) used for anti-rejction treatment. The expression of CD54 and HLA-DR increased up and down moderatly(p>0.05) in both the stable(A group) ,ATN group(C group) and normal control group(D group);the expression of CD54 and HLA-DR increased when acute rejection occured and there were significant deferences with the normal control group(D group)(P<0.05) at same term while significantly lower than the acute rejection group(B group)(P<0.05), then decreased after anti-rejection treatment.From the data,CD15s was proved to be higher sensitivity and more practical than CD54 and HLA-DR for the acute rejection diagnosis. Conclusion: The CD15s antigen is strongly expressed on the peripheral lymphocytes at the time of rejection. It is interesting that the efficacy of immunosuppress therapy in the patients with elevated creatinine could be predicted by CD15s expression on the peripheral lymphocytes before graft biopsy. There have been only few reports showing the relationship between CD markers and the efficacy of the treatment in patients with elevated creatinine. We report that the detection of CD15s on the peripheral lymphocytes by flow cytometry was an easy, helpful, and noninvasive means for the diagnosis and treatment of patients with elevated creatinine after renal transplantation. The up-regulated expression of CD15s,CD54 及 HLA-DR may be one factor of the molecule foundations for renal allogaft rejection,The immunosuppressants,especially MP,can suppress the CAMs expression evidently,which may be one of the most important mechanisms in protection from the early graft rejection and anti-rejective treatment.The dynamic investigation of CD15s,CD54 及 HLA-DR expression will be helpful for the rejection diagnosis and the estimation of anti-rejection effect.And the numerical data shows that CD15s has higher sensitivity and more practical than CD54 and HLA-DR for the acute rejection diagnosis.