腎移植患者におけるNatural Cell-MediatedCytotoxicityの検討

Abstract

同種生体腎移植44例について検討した.1)移植術直後よりNCMC活性は著しく低下し移植後6ヵ月を経ると更に低値をとりその傾向は腎移植後3年まで続き, 4年を経過すると, 再び高値をとる症例がみられた.2)急性拒絶反応合併時, NCMC活性は有意に高値を示したが, 慢性拒絶反応合併時は不変であった.3)免疫抑制剤とNCMC活性の検討よりNCMC活性の抑制に, 腎移直後より6ヵ月の期間ではSteroid剤及びAzathioprine (Az)剤の関与が, また, 腎移植後4年以降の時期ではAz剤の関与が示唆された

Natural cell-mediated cytotoxicity (NCMC) displayed by peripheral blood mononuclear cells of kidney allograft recipients was examined against K562 cells to demonstrate the kinetics of NCMC activity in the posttransplant period. On 44 kidney allograft recipients 301 NCMC assays were performed between 1 and 84 months after transplantation. These patients were treated with the conventional immunosuppressive treatment consisting of steroid and azathioprine. NCMC activity sharply decreased after transplant surgery. A decreased NCMC activity continued during the first 6 months and the mean NCMC value was 19.2 +/- 14.1. In the second 30 months, NCMC activity also constantly decreased, almost to 10. It was lower than that of the first 6 months (P less than 0.01). After 37 months, some patients restored a normal NCMC activity and others showed a decreased NCMC activity. The mean value was 27.4 +/- 20.6 in the third 48 months. The depression of NCMC activity might be caused by the large dose of steroid and azathioprine in the first 6 months. In the third 48 months, NCMC activity might be dependent on the dosage of azathioprine alone. The activation of NCMC activity might be caused by acute rejection crisis.