1647 THE UTILITY OF TRANSPLANT RENAL BIOPSY (TRB), Tc-99^IU SULFUR COLLOID SCAN (SCS), AND CYCLOSPORINE (CS) DRUG LEVELS IN DISTINGUISHING ACUTE REJECTION (AR) VERSUS CYCLOSPORINE NEPHROTOXICITY (NT)

Abstract

The use of CS immunosuppression in renal transplantation has made it increasingly difficult to ascertain the etiology of acute deteriorations in allograft function because of direct drug NT. We compared the utility of three diagnostic modalities-TRB, SCS and serum CS levels - to distinguish AR from CS NT in 19 children who received a primary transplant with CS therapy and 13 who were switched to CS from conventional treatment during the period 9/83-10/84.

The children (18M:14F) received 15 living-related and 17 cadaveric allografts. The three tests were performed whenever possible in 22/32 patients with suspected AR (mean interval of 3.2 months post-initiation of CS). Clinical response to anti-rejection therapy was the operational criterion for AR. A TRB was considered positive for AR if lymphocytic infiltration was noted, SCS was deemed positive if there was colloid uptake, and CS serum levels were considered positive if subtherapeutic (<100ng/ml) or in the toxic range (>500ng/ml).

We conclude that: 1)TRB is the most useful test for the diagnosis of AR episodes defined by response to anti-rejection therapy; and 2)SCS and CS drug levels correlate poorly with the TRB histological findings and the patient's clinical course.

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