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Background  The T-cell composition within the lymph node (LN) of end-stage renal disease (ESRD) patients differs from the composition within the circulation. Activation of the alloreactive T-cell response within secondary lymphoid organs is important after organ transplantation. However, to date no data are present on LN T-cell subsets and the risk for acute rejection after kidney transplantation.    Methods  T cells from LNs of ESRD patients were analyzed for frequency of recent thymic emigrants, relative telomere length, expression of differentiation markers, and were related to the development of early acute rejection (EAR), occurring within 3 months after renal transplantation (RT). Furthermore, the alloreactive potential of mononuclear cells isolated from the LN and peripheral blood of 10 patients was analyzed. Measures of alloreactive potential included proliferation, cytokine production, frequencies of interferon-gamma-producing cells, and the presence of cytotoxic molecules.    Results  Patients with EAR were younger ( p  = 0.019), cytomegalovirus-seropositive ( p  = 0.037) and usually received dialysis prior to RT ( p  = 0.030). Next to this, patients with EAR showed a lower CD4:CD8 ratio ( p  = 0.027) within the LN. T cells from the LN were similar with regard to alloreactive capacity compared with those within the circulation. Univariate regression analysis showed that the CD4:CD8 ratio (OR: 0.67,  p  = 0.039), patient age (OR: 0.93,  p  = 0.024), and preemptive RT (OR: 0.11,  p  = 0.046) were associated with EAR. After a multivariate analysis, only the CD4:CD8 ratio (OR: 0.58,  p  = 0.019) and preemptive RT (OR:0.05,  p  = 0.012) were associated with EAR.    Conclusion  A lower CD4:CD8 ratio in the LN is associated with a higher risk for the development of rejection within 3 months after RT.

T-Cell Composition of the Lymph Node Is Associated with the Risk for Early Rejection after Renal Transplantation