BERLIN (Reuters Health) - German scientists say they are close to developing
a post-transplant testing procedure that can identify early signs that
kidney transplant patients are rejecting the donated organ.

Under the direction of Professor Gerhard Opelz, the Heidelberg University
Hospital team has already developed a test to identify kidney transplant
patients most at risk of rejection.

It works by measuring blood levels of soluble CD30 -- a protein found on the
surface of certain white blood cells. In a study involving nearly 4,000
patients, published last year, Opelz and Dr. Caner Suesal found that the
higher the sCD30 level, the more likely a rejection reaction.

"This works as a predictive factor and we are now trying to establish its
importance in the early post-transplantation period to foresee an impending
rejection," Suesal told Reuters Health.

He said that pre-transplant tests could help doctors decide what regimen of
immunosuppressant drugs should be prescribed for a particular patient.

Those patients at greater risk can immediately be put on higher doses,
increasing the chance of success, while those at lesser risk can be put on
lower doses, reducing the risk of drug side-effects such as infections and
even cancers.

In February of this year, the team published the results of a small study
using the technique in post-transplant patients, in order to predict the
onset of rejection problems.

The study included 45 patients in the first days after transplantation. A
high level of sCD30 predicted the early onset of rejection several days
earlier than it was possible to determine using a biopsy of the transplanted
kidney.

"What is done at the moment is that if there is the suspicion of rejection,
around 10 days after transplantation, a biopsy is taken -- but this is
invasive," said Suesal.

"It would be much better if you could foresee the rejection in the
immunological process. This way we can identify patients with impending
rejection three to five days after transplantation."

"There are anti-rejection treatments which are very effective and
successful, but because of the side-effects they should be given to those
who need them."

He said he was looking at a routine which would take blood tests twice in
the first week after transplantation and then twice more by the 22nd day.

The test is cheap and easy to conduct, he said, costing around five euros
(US $5.38) each time and taking just four hours for a result.

Now, a further large-scale study is underway to try to confirm the results
of the smaller one. "This should be finished by the end of the year," he
said.

"Assuming that the bigger study goes as expected I would want everyone
receiving kidney transplants to get these tests."

The tests are not expected to work so easily with transplants of other
organs because long-term dialysis treatment experienced by nearly all kidney
transplant patients promotes the differentiated production of sCD30.

SOURCE: Journal of the American Society of Nephrology 2002;13:1650-1656;
Transplantation 2003;75:421-423.

____________

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