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Pre‐transplant immune state defined by serum markers and alloreactivity predicts acute rejection after living donor kidney transplantation
Author(s) -
Vondran Florian W.R.,
Timrott Kai,
Kollrich Sonja,
Steinhoff AnnKristin,
Kaltenborn Alexander,
Schrem Harald,
Klempnauer Juergen,
Lehner Frank,
Schwinzer Reinhard
Publication year - 2014
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12399
Subject(s) - medicine , immunosuppression , transplantation , immunology , cd8 , immune system , kidney transplantation , lymphocyte , tacrolimus , calcineurin , gastroenterology
Acute rejection (AR) remains a major cause for long‐term kidney allograft failure. Reliable immunological parameters suitable to define the pre‐transplant immune state and hence the individual risk of graft rejection are highly desired to preferably adapt the immunosuppressive regimen in advance. Donor and third party alloreactivities were determined by mixed lymphocyte cultures. Soluble forms of CD25, CD30, and CD44 were detected in patients' serum by ELISA. Various lymphocyte subpopulations were measured using flow cytometry. All patients received triple immunosuppression (tacrolimus/mycophenolate mofetil/steroids) and were grouped according to biopsy results within the first year: rejection‐free (RF, n = 13), borderline (BL, n = 5), or acute rejection (AR, n = 7). Patients with AR showed the highest pre‐transplant alloreactivities and serum levels ( sCD 25/ sCD 30/ sCD 44) according to the pattern RF < BL < AR. Relying on serum analysis only, multivariate logistic regression (logit link function) yielded a prognostic score for prediction of rejection with 75.0% sensitivity and 69.2% specificity. Patients with rejection showed markedly higher pre‐transplant frequencies of CD4 + /CD8 + T cells lacking CD28, but lower numbers of CD8 + CD161 bright T cells and NK cells than RF individuals. Pre‐transplant immune state defined by alloreactivity, serum markers, and particular lymphocyte subsets seems to correlate with occurrence of graft rejection after kidney transplantation. A prognostic score based on pre‐transplant serum levels has shown great potential for prediction of rejection episodes and should be further evaluated.