Prospective assessment of antidonor cellular alloreactivity is a tool for guidance of immunosuppression in kidney transplantation.

Abstract:

:Current characterization of the immune risk in renal transplant patients is only focused on the assessment of preformed circulating alloantibodies; however, alloreactive memory T cells are key players in mediating allograft rejection. Immune monitoring of antidonor alloreactive memory/effector T cells using an IFN-γ Elispot has been shown to distinguish patients at risk for immune-mediated graft dysfunction, suggesting a potential tool for immunosuppression individualization. In this nonrandomized study, we prospectively assessed donor and nondonor T-cell alloreactivity in 60 highly alloreactive patients receiving calcineurin inhibitor-based immunosuppression and in non-T-cell alloreactive transplant recipients treated with a calcineurin inhibitor-free regimen. The impact was evaluated using 1-year allograft outcome. We found a strong association between ongoing antidonor T-cell alloreactivity and histological lesions of acute T cell-mediated rejection in 6-month protocol biopsies, distinguishing those patients with better 1-year graft function, regardless of immunosuppression regimen. Interestingly, evidence for enhanced immune regulation, driven by circulating Foxp3-demethylated regulatory T cells, was only observed among patients achieving antidonor T-cell hyporesponsiveness. Thus, prospective evaluation of donor-specific T-cell sensitization may add crucial information on the alloimmune state of transplanted patients to be used in daily clinical practice.

journal_name

Kidney Int

journal_title

Kidney international

authors

Bestard O,Cruzado JM,Lucia M,Crespo E,Casis L,Sawitzki B,Vogt K,Cantarell C,Torras J,Melilli E,Mast R,Martinez-Castelao A,Gomà M,Reinke P,Volk HD,Grinyó JM

doi

10.1038/ki.2013.236

subject

Has Abstract

pub_date

2013-12-01 00:00:00

pages

1226-36

issue

6

eissn

0085-2538

issn

1523-1755

pii

S0085-2538(15)56114-0

journal_volume

84

pub_type

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