Use of Monoclonal Antibodies to T-Cell Subsets for Immunologic Monitoring and Treatment in Recipients of Renal Allografts

• Published in: The New England journal of medicine Vol. 305; no. 6; pp. 308 - 314
• Main Authors: Cosimi, A. Benedict, Colvin, Robert B, Burton, Robert C, Rubin, Robert H, Goldstein, Gideon, Kung, Patrick C, Hansen, W. Peter, Delmonico, Francis L, Russell, Paul S
• Format: Journal Article
• Language: English
• Published: United States Massachusetts Medical Society 06.08.1981
• Subjects: Antibodies; Antibodies, Monoclonal; Antilymphocyte Serum - immunology; Cytological Techniques; Graft Rejection; Humans; Immunosuppression; Kidney Transplantation; Lymphocytes; Rosette Formation; T-Lymphocytes - cytology; T-Lymphocytes - immunology; T-Lymphocytes, Regulatory - immunology; Transplantation, Homologous; Transplants & implants
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM198108063050603

Using monoclonal antibodies and flow cytometry, we serially monitored lymphocyte subpopulations in renal-allograft recipients treated with either conventional immunosuppression or a monoclonal antibody. In 29 patients given conventional suppression, highly significant correlations between changes in T-cell subsets and rejection were noted. Normal or elevated ratios of OKT4 (helper/inducer) to OKT8 (suppressor/cytotoxic) cells were associated with rejection unless the donor was HLA identical or the total number of T cells was extremely low. In patients with low ratios, rejection seldom occurred. Two patients treated with OKT3 monoclonal antibody for acute rejection had rapid disappearance of OKT3-reactive cells from the peripheral blood and prompt reversal of rejection. The use of monoclonal antibodies allows the precise determination of changes in T-cell subsets and promises the development of therapeutic protocols that can be designed to manipulate selected lymphocyte populations. (N Engl J Med. 1981; 305:308–14.) CONTINUING advances have improved survival rates in patients receiving renal allografts. Allograft survival, however, has not changed appreciably during the past decade. 1 , 2 During this period, patients have been treated with protocols that mainly include azathioprine, steroids, and antilymphocyte serum. One major limitation of current immunosuppressive treatment — a problem that may permit the loss of as many as half of all transplants from unrelated donors in the first year — is our inability to assess its continuing effects on individual patients except by the ultimate clinical outcome. Thus, rejection has been the only indication of insufficient suppression, and infection the . . .