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The main problem in the follow-up of patients receiving organ allografts is the early differential diagnosis of rejection episodes and infections. Serum levels of interferon gamma, a marker of T-lymphocyte activity, were determined with an immunoradiometric assay, specific for biologically active interferon gamma and sufficiently sensitive (20 U/l) for the determination of circulating interferon gamma. Neopterin, a pteridine released from stimulated macrophages, was determined by radioimmunoassay. Both rejection crises and infections are accompanied by distinct increases of serum neopterin (median values 124 and 128 nmol/l; N = 98). Interferon gamma levels are elevated for a short period one or two days earlier, the maximal values during infections (median 430 U/l, range 120-1220 U/l, N = 25) being higher than those during rejection episodes (median 120 U/l, range less than 20-330 U/l, N = 73). Each rise of interferon gamma was followed by an increase of neopterin, but not every neopterin increase was preceded by a interferon gamma peak. Neither of these parameters showed an increase during deterioration of kidney function due to cyclosporin toxicity. The determination of interferon gamma, a lymphokine involved in the activation of alloreactivity, reflecting T-cell stimulation, and the measurement of neopterin, a secretory product of activated macrophages, allows the simple, quick and reliable monitoring of the immune status of transplant recipients.

Neopterin and Interferon Gamma Serum Levels in Patients with Heart and Kidney Transplants