Nephrology Dialysis Transplantation, Vol 12, Issue 6 1199-1203, Copyright © 1997 by Oxford University Press
G Touchard, T Pasdeloup, J Parpeix, T Hauet, M Bauwens, G Dumont, P Aucouturier and J Preud'homme
Background. The occurrence of serum monoclonal
immunoglobulins in kidney transplant recipients is well known but their
significance and predictive value for the occurrence of lymphoma are a
matter of debate. We therefore conducted a study of monoclonal
immunoglobulins by a sensitive method during the long-term follow up of
grafted patients. Methods. Monoclonal immunoglobulins
were characterized by high-resolution electrophoresis, conventional
immunoelectrophoretic analysis, and a sensitive Western blotting procedure
in the serum from 84 renal transplant recipients prior to grafting and
subsequently, with a 1-8-year follow-up and excluding the patients who
developed posttransplant lymphoma. Results. Low
abundance monoclonal immunoglobulins were detectable prior to
transplantation in 56 cases (66.6%) and after graft in 72 cases (85.5%)
(and in 1 case (1.2%) and 18 cases (21.4%) of cases respectively, by
immunoelectrophoresis). These abnormalities were often multiple in
individual sera. Monoclonal components detected by immunoblotting were
transient in 23.8% of patients only (whereas those evidenced by
immunoelectrophoresis usually became undetectable by this method) and their
pattern was remarkably stable in the majority of cases. The frequency of
post-transplant monoclonal immunoglobulins was higher in patients of more
than 50 years of age than in younger patients. The appearance of monoclonal
components after grafting and their transient character correlated with CMV
infections. No correlation was found with various other parameters. The
isotypic distribution of monoclonal immunoglobulins with an IgM, IgG3, and
IgG1 predominance and an abnormally low &kgr;/&lgr; ratio was the
same as that observed in various immuno-deficiency states. The monoclonal
immunoglobulin pattern in three further patients who developed
post-transplant lymphoma was unremarkable. Conclusion.
Monoclonal immunoglobulins hence are not discriminant for lymphoma and
their characterization does not appear to be necessary in the evaluation of
followed up grafted patients, at least for a prediction of post-transplant
lymphoma. Keywords: cytomegalovirus; immunoblotting;
immunoelectrophoresis; kidney transplantation; monoclonal immunoglobulins;
serum
ORIGINAL ARTICLES
High prevalence and usual persistence of serum monoclonal immunoglobulins evidenced by sensitive methods in renal transplant recipients
Department of Nephrology and Laboratory of Immunology and Immunopathology (CNRS URA 1172 Immunology and Molecular Interactions), Poitiers University Hospital, F86021 Poitiers, France; Corresponding author
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