1048 IMMUNE RESPONSE IN UREMIC AND POST-TRANSPLANT CHILDREN

Abstract

Patients with chronic renal failure and renal allograft recipients have an increased incidence of infection. To define further the defect(s) in immune surveillance, children with chronic uremia, those on maintenance hemodialysis and those with well-functioning renal transplants were studied. Serum IgA, IgG and IgM levels, measured as an indicator of B-cell function, were reduced in all three groups. Intrinsic lymphocyte function was assayed by culturing patient cells in normal pooled plasma and stimulating them with phytohemagglutinin (PHA) or pokeweed mitogen (PWM). Mitogenic activity varied widely within each group but mean values were normal. The presence of an extrinsic inhibitor of lymphocyte activity was examined by culturing normal cells in patient plasma, again stimulating with PHA or PWM. Uremic plasma did not inhibit normal cell response to either PHA or PWM, but both pre- and post-dialysis plasma was markedly inhibitory. Plasma from transplant patients inhibited PHA response but not PWM response. Thus, uremic and transplant patients demonstrate a functional defect in B-cell activity. Although lymphocytes from these patients respond normally to mitogenic stimuli, plasma from dialysis (but not uremic patients) inhibits the mitogenic response of normal lymphocytes. Our data indicate that chronic hemodialysis affects humoral factors which influence lymphocyte activity. Immunosuppressive agents may contribute to the inhibition observed in transplant patient plasma.

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