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Rejection and immunosuppression in kidney transplantation.

Seventeen out of 85 renal allograft patients suffered 23 episodes of rejection. Of these 22 (96%) were associated with a significant increase in DNA synthesis in the peripheral blood and in 12 instances (55%) the DNA increase occurred before biochemical or clinical evidence. The prognostic value depends on the frequency of sampling and in all patients measured daily the DNA increase was predictive with a mean value of 7 days before other signs. Nine patients experienced 12 rejection episodes that resulted in the loss of their graft. All these cases of irreversible rejection were characterized by a significant elevation in DNA synthesis within 36 days of transplant. In 57 patients with good function 46 suffered 120 episodes of infection. DNA synthesis was increased in 12.5% of these. Thus an increase in DNA synthesis is 8 x more likely to be due to rejection than infection. The level of DNA and RNA synthesis may prove a useful guide for monitoring the level of immunosuppression in these patients.