[Immuknow and long term kidney graft].

INTRODUCTION: The survival of transplanted kidneys has improved over time, but there is an increased risk of neoplastic disease. In the long time follow up, non-melanoma skin cancers (NMSC) are the most frequent diseases and at the time of the occurrence of a NMSC we should evaluate a reduction or a change of IS. From a clinical point of view, the evaluation of immunosuppression is still a problem. The Immuknow assay may be of help in evaluating the immune response of transplanted patients. Here, by means of the ImmKnow assay, we tried to evaluate if long term renal transplant patients with NMSC are more immunosuppressed than patients without NMSC.

METHODS: 33 long term kidney transplant patients, 16 with NMSC and 17 without NMSC, were recruited and blood samples were drawn at baseline, 4 months, 8 months and 12 months to check renal function, blood levels of cni and to perform immuknow assay.

RESULTS: most values of T CD4+ reactivity were comprised between (atp) 225 and 525 ng/ml as for an moderate immunosuppression. No major differences have been observed between the two groups. No correlation with blood level of CNI was detected. T CD4+ activity changed over time for both the groups. 3 patients of the group without NMSC had levels of CD4+ reactivity constantly under (ATP) 225 ng/ml, classified as low per manifacturers definition.

CONCLUSION: in our limited experience the measure of cell-mediated immunity by immuknow assay years after transplantation, has not evidenced any significant difference between patients positive for NMSC and negative patients. We observed variation of the CD4 reactivity with time, no correlation with the level of CNI and the useful identification of some cases of low levels of cell reactivity.