Evidence that early acute renal failure may be mediated by CD3- CD16+ cells in a kidney graft recipient with large granular lymphocyte proliferation.

ABSTRACT

We report here on a patient with a large granular lymphocyte proliferative disease who received a third kidney allograft. This patient presented a lymphocytosis (culminating at approximately 30,000/mm3) with a large proportion (approximately 70%) of CD3- WT31- CD2+ CD16+ lymphocytes. Five days after a kidney graft and during prophylactic treatment by Ortho pan OKT3, he presented an acute graft failure with an apparent interruption of graft blood flow as assessed by the Tc99 scan pattern and an arteriogram. The biopsy showed an abnormal accumulation of intravascular CD3- CD16+ cells bound to endothelial cells with thrombilike patterns in small and middle-sized arteries, whereas CD3+ mononucleated cells infiltrate was restricted to interstitium as observed in his previous graft, performed before the appearance of the lymphoproliferative disorder. The syndrome resolved spontaneously. The role of OKT3-mediated release of cytokines able to upregulate endothelial cell adhesion molecules in triggering this phenomenon is discussed.