IL-6 determination in serum of kidney graft recipients by a new bedside test. its diagnostic relevance.
J. Kaden, G. May, V. Strobelt - Vivantes Institute of Laboratory Medicine, Berlin and Transplantation Centre Berlin, Charité
Introduction
The multifunctional Interleukin 6 (IL-6) is the main mediator of the acute phase reaction and earliest indicator of inflammation, tissue damage, hypoxia or infection. After kidney transplantation ongoing rejections are announced by elevated urinary but hardly serum IL-6 concentrations (Kaden J., R. Priesterjahn, Transplant Int 13[2000],S34-41). On the other hand the differentiation between bacterial and viral infections is relatively simple and valid by serum IL-6 concentration (Kaden J. et al. Transplant Int 9[1996], S63-67). The nowadays used immunoassays for IL-6 quantification are relatively time consuming, need a special technical support and welltrained laboratory staff. Recently a new IL-6 bedside test was introduced by Milenia Biotec. The results are available after 20 minutes by visual chip testing or photometry as preferred method. We evaluated this test with respect to its diagnostic significance at the first time after kidney transplantation. In a retrospective study a total of 269 Sera stored at -20 0C from 27 kidney graft recipients were selec-ted, blinded and measured „en bloc“. Patients Material Recipients Serum samples (stored at -20°C) Total number: n= 269 Procedure: Selection - Blinding - Measurement ‘en bloc’
Maximum panel cytotoxicity≤5% / >5% 21/6
No. of recipients No. of sera Selection of defined post transplant courses Basic immunosuppression Azathioprine (change to Cellcept in one case at day 30) Prednisolone No post transplant complication until discharge
Ciclosporin (change to FK 506 in one case at day 18)
Induction therapy (intraoperatively) CMV-infections
[Kaden J., Optimal management of induction therapy with ATG in kidney allograft recipients.
Rejection crises Bacterial infections IL-6 bedside test: MILENIA BIOTEC GmbH, 61231 Bad Nauheim, Hohe Str. 4-8, Germany. Volume of serum necessary: 100μl. Turn-a-round time: 20 min Visual interpretation: by means of an evaluation card. The colour intensity of the test band (caused by patient’s serum) is compared to different colour intensities shown on the evaluation card. Four different ranges of IL-6 levels are differentiated: <100, ≥100, ≥300, ≥1000 pg/ml Photometric measurement: by means of PicoScan. The IL-6 level is calculated according to a stored standard curve and allows the differentiation of six ranges: <50, 50-100, >100-200, >200-500, >500-1000 pg/ml. irreversible kidney graft rejection (CD1700) Vascular rejection complicated by a positive blood culture (CD 1822) IL-6 values (bedside test) in 4 different clinical situations after kidney transplantation No complication Viral infection Rejection Bacterial infection
12 15 19 22 26 29 33 35 37 40 43 47 49 51 54 57 61 64 68
Elevation of IL-6 serum concentration in connection with a bacterial infection complicating a reversible vascular rejection.
Elevation of IL-6 serum concentration in connection with an irreversible graft rejection indicating a strong inflammatory process.
The occurrence of CMV-pp65 antigen, however, was not associated with changed IL-6 level. Ectomy of a functioning kidney graft as a result of an incurable infection ( CD 1814) Conclusions
Viral infections did not result in an increase of IL-6 more than
2. The diagnostic relevance of this new quantitative IL-6 bedside test
is as high as that of other enzymimmunoassays.
3. Advantages: The results are obtained already after 20 minutes and
All data within +7/-7 days All data within +7/-7 days All data within +7/-7 days
with respect to the begin- with respect to the first
4. If possible, photometry should be preferred to visual chip reading
Long-lasting elevation af IL-6 serum concentration during an incurable staphylococcus aureus infection. Address: Dr. Jürgen Kaden, Klinikum im Friedrichshain, Institute of Laboratory Medicine, Landberger Allee 49, 10249 Berlin, Germany
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