Soluble human leukocyte antigen-G (SHLA-G) in Tunisian kidney transplantation.

To investigate the relationship between the soluble HLA-G (sHLA-G) and the appearance of acute renal rejection (AR) episodes we have quantify in this study the level of sHLA-G by enzyme-linked immunosotrbent assay in 42 kidney transplant patients classified in two groups: G1: 17patients with acute rejection (AR+) and G2: 25 patients without AR (AR-). To establish our normal sHLA-G ranges, serum samples from 18 healthy controls were tested. Pre-transplantation sHLA-G levels were significantly increased in patients (mean +/- standard error of the mean, 60.48 +/- 12.18 units/ml) than healthy subjects (19.11 +/- 4.9 units/ml) (p = 0.001). Although the difference was not statistically significant, G1 patients (AR+) revealed lower levels of sHLA-G (mean +/- standard error of the mean, 31.25 +/- 6.71 units/ml) compared to G2 patients (AR-) (53.43 +/- 1721 units/ml). Nevertheless, the course of total sHLA-G levels was nearly identical in patients with and without rejection. Nonparametric analysis revealed that pre-transplantation levels of sHLA-G < 18.00 units/ ml (sensitivity: 87.8% and specificity of 72.2%) were not related to rejection. Also, multivariate analysis regarding anti-HLA antibody status, recipient age and gender showed that sHLA-G could not be an independent risk factor for renal graft rejection. However, a higher sera levels of sHLA-G seemed to contribute to better kidney allograft survival rate after 10 years of follow-up (significance tendency: p = 0.091) as shown by the survival analysis. Because of the small number of subjects studied, these results must be treated with caution. A much larger cohort of kidney transplant patients according to acute rejection would seem necessary to confirm these findings.

Mannose binding lectin (+54) exon 1 gene polymorphism in Tunisian kidney transplant patients.

Mannose-binding lectin (MBL), a collagen-like serum protein, is a key component of innate immunity. MBL binding to carbohydrates present on pathogens mediates lectin-dependent activation of the complement pathway. There is growing interest in the importance of innate immunity in host defense, particularly when adaptive immunity is compromised. Three single nucleotide polymorphisms (SNPs) of the MBL gene have been described in the first exon to be associated with low MBL serum concentrations as well as impaired MBL structure and function. Clinical studies have shown that these MBL SNPs are associated with increased susceptibility to infections, especially in immunocompromised patients. To investigate the association between acute kidney transplant rejection and polymorphism at codon 54 of the MBL gene, the DNA genomic of 133 renal transplant recipients and 117 healthy blood donors was analyzed by restriction fragment length polymorphism-polymerase chain reaction. The patients were classified into two groups: group 1 included 32 HLA-identical recipients and group 2, 101 one haplo-identical recipients. Forty-eight (36.1%) subjects had developed one or more acute rejection episodes (AREs) within the first 6 months after transplantation: 9 in group 1 (28.12%) and 39 in group 2 (38.61%). The genotype and allele frequencies of (+54) MBL gene polymorphism among patients and controls did not reveal a significant difference. However, the frequency of MBL-B mutant allele was increased among patients with AREs compared with those without AREs: group 1 (0.167 vs 0.065) versus group 2 (0.205 vs 0.105). Although the difference was not significant, perhaps because of the small number of patients, the MBL at codon (+54) polymorphism could be involved in the susceptibility of Tunisian kidney transplant recipients to acute allograft rejection episodes.

The first year renal function as a predictor of long-term graft survival after kidney transplantation.

This study examined the impact of graft function at the end of the first year after kidney transplantation on long-term graft survival. We analyzed the roles of serum creatinine (Scr) and other variables as predictors of graft survival among 235 adult kidney transplant patients. The subjects were divided into 3 groups according to their Scr at the end of the first year: group 1, Scr < 100 micromol/L; group 2, 100 micromol/L < or = Scr < or = 150 micromol/L; and group 3, Scr >150 micromol/L. The annual rate of graft loss of 0.7% (95% confidence interval [CI], 0.63-0.77) in group 1, was lower than those in group 2 (2.1%; 95% CI, 2.02-2.18; P < .0001) and group 3 (6%; 5.74-6.26; P < .0001). Regression analysis showed the role of recipient age at the time of operation, and Scr level at the end of the first year to be independent predictors of graft loss. Graft survival was not influenced by any other studied parameter, including donor age, year of procedure, warm ischemia time, history of acute tubular necrosis, and occurrence of an acute rejection episode. We conclude that the 1-year Scr value predicts long-term renal graft survival, representing a simple, practical tool to identify recipients with an high risk for late graft failure.

The PTPN22 C1858T (R620W) functional polymorphism in kidney transplantation.

To investigate the association between kidney transplant rejection and PTPN22 (protein tyrosine phosphatase non-receptor 22) polymorphism, genomic DNA of 175 renal transplant recipients and 100 healthy blood donors were genotyped by restriction fragment length polymorphism-polymerase chain reaction. The patients were classified in two groups: G1 included 33 HLA-identical recipients and G2 included 142 with one or more HLA mismatches. Forty-nine patients developed an acute rejection episode (ARE): 8 in G1 and 41 in G2. The allelic frequencies of PTPN22 R620W revealed a significant difference between patients and controls. In fact, the W-allele was significantly more frequent in graft recipients than in blood donors (0.05 vs 0.01, P < .05). Furthermore, the frequency of this allele was increased in G1 patients with an ARE (0.188) compared with those without an ARE (0.040), but the difference was not statistically significant. Thus, we concluded that the PTPN22 W-variant allele could be involved in the susceptibility to acute allograft rejection in Tunisian kidney transplant patients.

Kidney transplantation: Charles Nicolle Hospital experience.

The aim of our retrospective study was to analyze the short- and long-term follow-up of 298 renal transplantations performed between June 1986 and May 2005. All were first transplantations except 4 cases, with 54 from cadaveric and 244 from living donors. The recipients included 196 males and 102 females of overall mean age of 31.21 +/- 8.9 years (range, 16-61 years). A combination of prednisolone and azathioprine was presented for 212 patients or mycophenolate mofetil for 86 patients. Polyclonal or monoclonal antibodies were used as induction therapy in 183 cases. Cyclosporine was administered to 188 cases and tacrolimus only to 16. HLA matching was 0 mismatches (MM) in 65 cases; 1 or 2 MM in 113; 3 MM in 99; and > or =4 MM in 21. Acute tubular necrosis occurred in 45 cases. One hundred eighteen patients experienced at least 1 acute rejection episode: 102 cases (41.8%) among living and 16 (29.6%) among cadaveric kidneys donor (P = .0007). The actuarial patient and graft survival rates at 1, 5, 10, 15, and 20 years were 95.9%, 87.4%, 77.5%, 65.6%, and 60.8%, and 94.9%, 84.5%, 75.4%, 65.4%, and 53%, respectively. Sixty-three patients died and 72 patients returned to dialysis. Our results were comparable to experienced centers. However, the member of kidney transplantations does not match the increased number of patients on renal replacement therapy. It is advisable to promote obtaining organs from brain-dead donors.

[Association of disseminated nocardiosis and Kaposi's sarcoma after kidney transplantation]. / Nocardiose disséminée associée à un sarcome de Kaposi après transplantation rénale.

We report a 40-year-old kidney recipient who developed disseminated nocardiosis associated with cutaneous Kaposi's sarcoma. The withdrawal of immunosuppressive therapy and prolonged antibiotic therapy, including imipenem and trimethoprim-sulfamethoxazole, resulted in a favourable outcome of both disorders. Three years later, graft function remains stable with a complete regression of skin and pulmonary abnormalities. This case report illustrates the predisposing role of immunosuppressive treatment in the occurrence of infectious and neoplastic complications observed after solid-organ transplantation.

[Peritoneal dialysis in the elderly]. / La dialyse peritoneale chez le sujet age.

BACKGROUND: Peritoneal dialysis is used more and more as treatment of substitution of the end stage renal disease at the old subjects of more than 65 years and its effectiveness and its good tolerance were shown. AIMS: To study the epidemiological and clinical profile of these patients, the indication and the advantages of PD, the various complications, the elements of prognostic and the survival of the patients and the technique. METHODS: We made a retrospective study including a series of 13 old patients of more than 65 years and treaties by PD during the period extending from the 1983/2/11 to the 2005/12/31. They are 10 men and 3 women on average of 70 +/- 3.1 year and representing 3.62% of the totality of the patients. The diabetic and vascular nephropathies represent the first cause of ESRD. RESULTS: The PD was used of first intention at 53.84% of the patients whose majority suffers from a malnutrition due to advanced age, anorexia, psychological disorders, bad dental state and uraemia. The cardiovascular complications are frequent in this age bracket explaining heavy morbidity. The pulmonary and urinary infectious complications are also frequent. The more frequent peritonitis compared to the literature, are comparable between the 2 age brackets < and = with 65 years and the mode of PD (APD or CAPD). The time separating the beginning from PD and which has occurred of the peritonitis is shorter in APD. The lesions of renal osteodystrophy are found among 6 patients: 3 cases of hyperparathyroidism and 3 cases of adynamic osteopathy. The return in HD is rare due to dysfunction of the catheter. The survival of the patients is 92.8% at 1 year and 60.8% at 5 years; that of the technique is worse with 88.3% at 1 year and 33.7% at 5 years Eight patients died (61.5%) because of cardiovascular diseases and of the infections. We found a correlation statistically significant between the survival of the patients and the mode of PD, on the other hand any correlation was not found with the age or the sex. The survival of the technique is not correlated to a significant degree with the age, the sex and the mode of PD. CONCLUSION: Peritoneal dialysis is used of first intention at more half of the old subjects and remains a last recourse for haemodialysis which have an initially vascular problem. The family support and the good nurse allow these patients to adhere well to the technique. The cardiovascular diseases and the infections are responsible for heavy morbi-mortality. The survival of the technique is worse than that of the patients.

Prevalence of autoantibodies in a Tunisian cohort of hepatitis C virus infected dialysis patients.

The hepatitis C virus (HCV) is the principal agent of viral chronic hepatitis. Cirrhosis and hepatocellular carcinoma are the major complications of this chronic infection. In haemodialysis, HCV infection remains a very frequent problem. Several autoimmune phenomena have been described during this infection. Two hundred haemodialysis patients, all of them anti-HCV (+), were included in this study to evaluate the frequency of Anti-Nuclear Autoantibodies (ANA), anti-cardiolipine antibodies (ACL), anti-smooth muscle antibodies (ASMA), anti-mitochondria antibodies (AMA), anti-thyroperoxydase antibodies (ATPO) and Rheumatoid Factor (RF) comparing them to healthy controls. Sixty eight serums (34%) patients were positive to at least one of the auto-antibodies tested. The difference between patients and controls was statistically significant. These markers were dominated by RF of the IgM isotype and ACL of the IgG isotype. Nevertheless, the positivity of ANA, ASMA, AMA and ATPO was not statistically different comparing to the controls. In addition, an association between the presence of the auto-antibodies and the viral replication was found suggesting that HCV is responsible for inducing these autoimmune phenomena.

[Lymphoproliferative disorders in kidney transplant recipients: incidence, clinical characteristics and outcome]. / Syndromes lymphoprolifératifs après transplantation rénale: incidence et particularités cliniques et évolutives.

PURPOSE: The aim of this study was to determine the epidemiological and the clinical characteristics of post-transplant lymphoproliferative disease (PTLD) and to evaluate its impact on patients' and grafts' survival. PATIENTS AND METHODS: Three hundred and sixteen adult kidney recipients, transplanted between June 1986 and May 2006, were included. The incidence rates were calculated by dividing the number of different events (PTLD, death and graft-loss) by the total duration of follow-up. The survival rates and the cumulated frequency of PTLD were calculated according to the actuarial method. RESULTS: Seven recipients developed PTLD during a cumulated follow-up of 2202 years. The annual incidence was of 0.32% (95% CI : 0.30-0.34). It was of 0.81% (0.70-0.92) in recipients of kidneys from deceased donors, and of 0.25% (0.23-0.27) in patients transplanted from living donors (NS). The delay after transplantation for the diagnosis of PTLD ranged from 7.4 months to 7.7 years. PTLD was a B cell lymphoma in six cases and affected extra nodal sites in most of the cases. The treatment, comprising the cessation of immunosuppressive therapy in all cases, resulted in complete remission in four patients. Three patients died, representing an annual death rate of 6.1%, versus 2.8% in patients without PTLD (NS). The annual incidence of graft loss was 6.1% versus 3.2% among patients without PTLD (NS). CONCLUSION: PTLD was observed in 2.2% of our patients, with an annual incidence of 0.32%. It resulted in a decrease of both patients' and grafts' survivals. Preventive measures, including the improvement of the monitoring of immunosuppressive drugs and the prevention of viral infections, should be considered to reduce the risk of PTLD.

Impact of Interleukin-17F Gene Polymorphisms in Outcome of Kidney Transplantation in Tunisian Recipients.

BACKGROUND: Genetic polymorphisms of interleukin (IL)-17F, associated with functional and/or quantitative change in this glycoprotein, have been described as predisposing to various autoimmune diseases. The proinflammatory IL-17 has some roles in renal transplantation. In this context, the relationship between the most common IL-17F polymorphisms with acute renal allograft rejection susceptibility in Tunisian renal recipients has been investigated. METHODS: We examined 93 renal transplant recipients who were enrolled and classified as follows: GI, 48 transplant recipients who developed at least one episode of acute rejection; and GII, 45 controls, kidney recipients who also were followed for at least 1 year and had stable renal function. Single nucleotide polymorphisms (SNPs) of IL-17F gene, including -1507 C/T (rs18889570), 7384 A/G (rs2397084), 7469 C/T (rs11465553), and 7489 A/G (rs763780), were evaluated using direct sequencing. RESULTS: No statistically significant association of the IL-17F SNPs studied with the onset of acute rejection was observed. However, AA genotype on 7489A/G SNP showed anti-HLA antibodies less than other genotypes and a higher graft survival time (P = .017). CONCLUSION: The AA genotype on 7489A/G SNP of IL-17F and the A allele might be associated with a lower risk of acute rejection with better graft survival.

Adhesion molecule polymorphisms in acute renal allograft rejection.

Acute rejection is the main cause of early renal allograft failure. Adhesion molecules provide signals for activation and recruitment of effector cells leading to graft infiltration by host T cells, which are key to allograft rejection. This study was undertaken to analyze the adhesion molecule gene polymorphisms in renal transplant recipients and to investigate their potential association with the development of acute allograft rejection. A total of 120 renal transplant recipients and 100 controls were retrospectively genotyped. Seven nucleotide polymorphisms in intracellular adhesion molecule (ICAM)-1, platelet endothelial cell adhesion molecule (PECAM)-1, L-selectin, and E-selectin were analyzed using allele-specific polymerase chain reaction (PCR)-SSP assay and PCR-restriction fragment length polymorphism (RFLP). Recipients were selected on the basis of the development of acute allograft rejection in the first 6 months after renal transplantation. Forty-one patients developed acute allograft rejection and 79 showed uneventful courses. There was no evidence for an association of any polymorphism with acute rejection. Thus, we concluded that these genes do not predispose to acute renal allograft rejection.

Human platelet antigens: HPA-1, -2, -3, -4, and -5 polymorphisms in kidney transplantation.

To investigate the association between kidney transplant rejection and polymorphisms of HPA-1, -2, -3, -4, and -5, the genomic DNA of 70 renal transplant recipients and 100 healthy blood donors was analyzed by polymerase chain reaction (PCR)-SSP. The patients were classified into two groups. Group 1 included 33 HLA-identical recipients and group 2, 37 one haplo-identical recipients. Thirty-one recipients experienced an acute rejection episode (ARE): 10 in group 1 and 21 in group 2. Ten group 2 patients developed chronic allograft dysfunction (CAD). Before transplantation, five patients in group 1 were lymphocytocytotoxic antibodies (LCT) positive, among them three developed an ARE. In group 2, seven recipients were LCT positive and four had an ARE. After transplantation, 29 patients were LCT positive: 11 in group 1 and 18 in group 2, among them: 6/11 and 11/18 had an ARE. The allelic frequencies of HPA-1, -2, and -5 among patients and controls did not reveal significant differences, whereas the HPA-3a and HPA-4b alleles were significantly more frequent among patients than controls: 91.4% and 27.8% versus 76.5% and 11.5% respectively (P < .05 and P < .001). The frequency of the HPA-3b allele was increased in patients with an ARE (11.3%) and those who developed CAD (20%) compared with those not affected by these complications (6.6% and 6.4%, respectively), but the difference was not significant. The genotype distribution of HPA-1, -3, and -4 genes of GPIIb/IIIa revealed that the most frequent genotype was HPA-1a1a/3a3a/4a4a (19%) among controls and HPA-1a1a/3a3a/4a4b (31.4%) among patients. This genotype was associated with an ARE in 25.8%, namely 50% of group 1 recipients and 14.28% of group 2. The HPA-4b polymorphism of GPIIb/IIIa receptor seem to be an independent risk factor for acute allograft rejection in kidney transplantation.

Tuberculosis after renal transplantation.

Tuberculosis (TB) remains a major public health problem in our country. Its diagnosis in immunodeficient patients is difficult. In this retrospective study, we analyzed the prevalence, clinical presentation, and outcome of TB after renal transplantation (RT) in our Tunisian team's experience. Among 359 renal transplant recipients, 9 (2.5%) developed TB at 49.6 months (range, 3-156 months) after RT. There were 7 men and 2 women of mean age 37.8 years (range, 15-53 years). The organs involved included lymph nodes in 1 case; lung in 5 cases; genitourinary system in 1 case; rachis in 1 case; pleural in 1 case; and both pulmonary and urinary systems in 1 case. The diagnosis was bacteriologic in 6 cases; histologic in 1 case; and 2 patients had a high index of suspicion. All patients were treated with a combination of rifampicin, isoniazide, pyrazinamide, and ethambutal. Recurrence of TB infection was noted in 3 cases with multiple localizations: lymph node, muscle abscess, meningitis, genitourinary system, rachis, and lung. Two patients died. In conclusion, among renal transplant patients, extrapulmonary involvement and recurrence of TB were frequent.

Avascular osteonecrosis after renal transplantation.

Avascular osteonecrosis (AVN) is a serious osseous complication after renal transplantation. Its prevalence clearly decreased from 20% to 4% after introduction of cyclosporine and reduction of steroid doses. The aim of our study was to evaluate the frequency of AVN among kidney transplant recipients and to determine the risk factors by comparing them with a population without AVN. Among 326 kidney transplant recipients between June 1986 and December 2004, 15 patients developed AVN with mean age of 40.86 years, including 11 men and 4 women. Fifteen kidney transplant recipients without AVN were selected to be matched for age, gender, and date of transplantation (control group). Cases of symptomatic AVN were diagnosed by hip X-ray, radioisotope bone scan, or magnetic resonance imaging. AVN was diagnosed at a mean of 3.5 years after transplantation (range, 0.5-13 years). The main localization of AVN was the femoral head in 12 cases and the femoral condyle in 3 cases. We studied the following risk factors: the type of donor (cadaver or living donor), the duration on dialysis before transplantation, the cumulative steroid dose, the acute rejection rate, and the posttransplantation weight gain. Statistical analysis showed that the cumulative steroid dose and the acute rejection rate were higher among the AVN group than the control group (P=.04 and P=.058, respectively). The prevalence of AVN in our population is 4.6%, which is probably an underestimate since these were symptomatic cases. The reduction or early withdrawal of steroids remains the only efficient preventive treatment for AVN.

Pustular psoriasis after renal transplantation.

Cutaneous manifestations in renal transplant recipients are frequently represented by infections and cancerous lesions. However, dermatologic lesions secondary to autoimmune diseases are rare. We report a case of pustular psoriasis occurring after renal transplantation in a 31-year-old woman with a history of vitiligo. The patient was on hemodialysis for 2 years for undetermined chronic nephropathy. She received an HLA identical live related transplant from her brother. She was maintained on an immunosuppressive regimen of corticosteroids, azathioprine, and cyclosporine, which was replaced with mycophenolate mofetil because of neurotoxicity and azathioprine was stopped. Thirty-one months after renal transplantation, she developed pustular psoriasis which was treated with retinoids; she experienced a relapse and resistance to treatment despite the reintroduction of cyclosporine.

Impact of dialysis modality on posttransplantation results in kidney transplantation.

Studies looking at the type of pretransplantation renal replacement therapy on graft and patient survivals after kidney transplantation have produced conflicting results. Therefore, we studied the effect of pretransplantation dialysis modality (peritoneal dialysis [PD] or hemodialysis [HD]) on transplant outcomes. We performed a retrospective study of 78 patients (39 PD and 39 HD) who had their first renal transplantation between January 1986 and December 2004. Comparisons between groups were made using chi-square tests for qualitative parameters and nonpaired Student t tests for continuous variables. Comparisons between actuarial curves of patient and technique survivals used log-rank tests. The percentages of recipient males, cadaveric donors, transplant-induced diabetes, mean period of dialysis, mean transplantation follow-up, mean duration of first hospital stay, first infection, acute tubular necrosis, and acute rejection episodes were not significantly different among PD versus HD patients, whereas recipient and donor mean ages were significantly higher in HD and PD patients, respectively. There were no differences in graft and recipient survivals among PD versus HD patients. After kidney transplantation, there was no difference between PD and HD patients concerning percentages of infection, acute tubular necrosis, acute rejection episodes or graft and recipient survivals.

Risk factors of arterial hypertension after renal transplantation.

Arterial hypertension often present after kidney transplantation is of multifactorial origin. The aim of this study was to determine the role of donor and recipient factors in the development of hypertension after renal transplantation. We retrospectively analyzed the data of 280 patients transplanted between 1985 and 2005, who still had functioning grafts at 1 year after transplantation. We recorded donor and recipient parameters. One hundred eighty-seven patients (66.8%) were hypertensive. Upon multivariate analysis of recipient factors, pretransplant hypertension (odds ratio) [OR]: 8.5, 95% confidence interval [CI]: 4.5 to 16.1); serum creatinine level > 130 micromol/L at 6 months (OR: 2.5, 95% CI: 1.3 to 4,7), male gender (OR: 2.02, 95% CI: 1.2 to 3.4), and chronic rejection (OR: 2.4, 95% CI: 1.2 to 4.7) were independent predisposing factors. Among donor factors, age was significantly associated with arterial hypertension upon univariate analysis. In conclusion, recipient factors, especially pretransplant hypertension, contribute to the disorder in renal transplant patients.

Visceral leishmaniasis in adults with nephropathy.

The aim of this study is to evaluate the features of visceral leishmaniasis (VL) in adults with nephropathy, who were not infected with the human immunodeficiency virus. This is a retrospective study of 14 adults hospitalized between 2000 and 2014, with VL and renal involvement. Clinical, biological, and therapeutic data were collected from the patients' medical files. Eleven women and three men, most of whom were from the North of the country, with a mean age of 40.5 years were studied. Lupus was present in five cases, the Sicca syndrome in three cases, diabetes in one case, renal failure on dialysis in two cases, and there were three renal transplant recipients. Major clinical symptoms were fever and weakness in all cases. Enlargement of the spleen was present in eight cases and hepatomegaly in six cases. Biologic inflammatory syndrome and anemia were present in all cases, and pancytopenia was present in seven cases. Renal insufficiency was noted in all cases. Diagnosis of VL was confirmed by bone marrow examination or serology. Treatment consisted of antimoniate in 10 cases and amphotericin B in four cases. Seven deaths were recorded. Clinical symptoms of VL are atypical in patients with nephropathy and therefore, the diagnosis should be suspected in such patients because VL is still endemic in our country.

Polymorphism of the renin-angiotensin-aldosterone system in patients with chronic allograft dysfunction.

Polymorphism of the gene encoding components of the renin-angiotensin-aldosterone synthase system (RAAS) represents an area of intense research of cardiovascular disease associations. Numerous studies have addressed the role of RAAS gene polymorphisms in the development and progression of renal disease. Also, it has been reported that patient with ACE (DD) and angiotensinogen AGT (TT) genotypes are associated with chronic allograft dysfunction (CAD). We investigated the effects of gene polymorphisms of the renin-angiotensin-aldosterone system in renal transplant patients (81 males and 50 females; mean age 29.6+/-10.2 years). Genotypes were determined using polymerase chain reaction sequence specific primers and PCR followed by RFLP analysis. Renal allograft recipients with chronic allograft dysfunction had significantly higher frequencies of the MM genotype than those without CAD (P<0.05). The other genetic polymorphisms of the RAAS were not associated with CAD. This study proves that determination of AGT M235T genotype before transplantation may help identify patients who are at risk for chronic renal transplant dysfunction.

Plasma levels of soluble CD30 in kidney graft recipients as predictors of acute allograft rejection.

In renal transplant recipients elevated soluble serum CD30 levels are associated with increased rejection and graft loss. We sought to determine the sCD30 plasma levels before and after kidney transplantation and to assess whether sCD30 was a predictive factor of immunological risk. sCD30 plasma levels were determined by an enzyme-linked immunosorbent assay assay in 52 kidney graft recipients before as well as 7, 15, and 21 days after transplantation. Eighteen patients developed acute allograft rejection (group I) and 34 patients showed uneventful courses (group II). Before transplantation sCD30 plasma levels were elevated in both groups (mean: 162.6 +/- 89.5 U/mL). After transplantation, group I recipients with acute rejection showed higher relative levels of plasma sCD30 on days 7 and 15 (120.8 +/- 74.6 U/mL and 210.6 +/- 108.7 U/mL respectively) compared with group II patients without rejection (95 +/- 45 U/mL and 59.4 +/- 31.6 U/mL), a difference that was significant for group I (P = .0003) and not significant for group II (P = .09). On day 21, sCD30 decreased in the two groups but remained higher among group I patients (120.6 +/- 92.7 U/mL). HLA antibodies were positive in 18 patients (34.6%) with 9 (50%) experiencing at last one episode of acute rejection. Among 34 patients negative for anti-HLA antibodies, nine displayed acute rejection only (26.4%), a difference that was not significant (P > .05). If we consider 100 U/mL as the minimum predictive level for allograft rejection, our results suggested that levels of sCD30 should be taken into consideration with the presence of HLA-antibodies detectable before and after transplantation, especially in patients with more than three HLA mismatches [RR = 3.20 (0.94 < RR < 10.91)]. These data suggested that measurement of plasma sCD30 is a useful procedure for the recognition of rejection in its earliest stages.