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During the past decades, organ transplantation has become a frequently performed routine procedure offered to patients with end-stage organ failure. Transplant recipients live longer, have a good quality of life, and represent therefore a rapidly growing population. Although the follow-up, and especially the immunosuppressive therapy, are maintained by specialized transplant centers, such patients increasingly appear in private offices or hospitals that lack particular expertise in transplant medicine. Thus, there is need for an educational network for physicians and health care workers and for guidelines how to care best for this cohort of patients.

Measurement of various acute phase proteins (CRP, α1-proteinase inhibitor = a1-PI, transferrin = TRF, prealbumin = PAB) and neopterin was performed in sera from kidney graft recipients, who were given OKT3 for the treatment of acute rejection episodes. All acute phase proteins and the serum neopterin/creatinine ratio (Npt/Cr) showed a significant increase/decrease after initiation of monoclonal antibody therapy. In patients with no increase in anti-OKT3 antibodies within 3 months after initiation of OKT3 therapy, the increase in al-PI was less pronounced than in antibody positive patients (ab negative: 185 ± 48 mg/100 mL to 217 ± 49 mg/100 mL; ab positive: 213 ± 54 mg/100 mL to 300 ± 54 mg/100 mL). Variations in the other parameters tested were similar in both groups.

Despite many atempts to find reliable methods for immunological graft monitoring most parameters ([1]–[4]) failed to become established for clinical routine. The reason for this failure is mainly due to a lack of specificity i.e. most parameters are elevated not only in case of rejections but also in bacterial or viral infections. In order to find a more sophisticated method we tested a two marker model. Two different parameters were determined for immune monitoring of kidney grafts. Serum neopterin (sNPT) as unspecific marker ([5]–[7]) was used to indicate conditions of “immunological activation” i.e. acute rejections and infection episodes. Serum gamma interferon levels (sGIF), however, which have been found to be significantly elevated in infections only were used for further differentiation.