Preformed Donor-Reactive T-Cells That Persist after ABO Desensitization Independently Predict Severe Acute Cellular Rejection after Living Donor Kidney Transplantation

T. Schachtner,^1,2,3 M. Stein,² P. Reinke.^1,2

¹Nephrology and Internal Intensive Care, Charite Campus Virchow Clinic, Berlin, Germany
²Berlin-Brandenburg Center for Regenerative Therapie (BCRT), Charite Campus Virchow Clinic, Berlin, Germany
³Berlin Institute of Health (BIH), Charite and Max Delbrueck Center, Berlin, Germany.

Meeting: 2018 American Transplant Congress

Abstract number: 328

Keywords: Kidney transplantation, Rejection, T cells

Session Information

Session Name: Concurrent Session: Kidney Immunosuppression: Desensitization

Session Type: Concurrent Session

Date: Monday, June 4, 2018

Session Time: 4:30pm-6:00pm

Presentation Time: 5:30pm-5:42pm

Location: Room 4B

Donor-reactive T-cells have been suggested to impact allograft outcome due to a higher incidence of acute celluar rejection. These donor-reactive memory T-cells rapidly acquire effector functions and have been shown to be relatively resistant to standard immunosuppressive regimens.

We analyzed 150 living-donor kidney transplant recipients (KTRs) from 2008 to 2016. KTRs were grouped into 92 ABO-compatible (ABOc) KTRs and 58 ABO-incompatible (ABOi) KTRs. Samples were collected at 6 timepoints, before rituximab and maintenance immunosuppression, before immunoadsorption, before transplantation, at +1, +2, and +3 months posttransplantation, and donor-reactive T-cells were measured by interferon-γ Elispot assay.

Among 150 KTRs, 32 KTRs (21%) showed preformed donor-reactive T-cells, whereas 118 KTR (79%) didn't. 8/20 ABOc-KTRs (40%) with preformed donor-reactive T-cells showed acute cellular rejection, whereas 17/72 ABOc-KTRs (24%) without preformed donor-reactive T-cells developed acute cellular rejection (p=0.163). 7/12 ABOi-KTRs (57%) with preformed donor-reactive T-cells showed acute cellular rejection within the first posttransplant year, whereas only 3/46 ABOi-KTRs (7%) without preformed donor-reactive T-cells developed acute cellular rejection (p=0.001). Interestingly, 6/7 ABOi-KTRs (86%) with preformed donor-reactive T-cells that persist after ABO desensitization developed acute cellular rejection, whereas only 1/5 ABOi-KTRs (20%) with preformed donor-reactive T-cells that disappeared during ABO desensitization showed acute cellular rejection (p=0.072). Among 118 KTRs without preformed donor-reactive T-cells, 10/72 ABOc-KTRs (14%), but 0/46 ABOi-KTRs (0%) developed de-novo donor-reactive T-cells (p=0.006).

The presence of preformed donor-reactive T-cells puts KTRs at an increased risk of acute cellular rejection. Strategies to provide a better risk stratification within this high-risk group, however, don't exist. Here, preformed donor-reactive T-cells that persist despite initiation of CNI-based maintenance immunosuppression identifies KTRs at highest risk of acute cellular rejection. Less de-novo donor-reactive T-cells after ABO desensitization may account for less acute cellular rejection among ABOi-KTRs.

CITATION INFORMATION: Schachtner T., Stein M., Reinke P. Preformed Donor-Reactive T-Cells That Persist after ABO Desensitization Independently Predict Severe Acute Cellular Rejection after Living Donor Kidney Transplantation Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Schachtner T, Stein M, Reinke P. Preformed Donor-Reactive T-Cells That Persist after ABO Desensitization Independently Predict Severe Acute Cellular Rejection after Living Donor Kidney Transplantation [abstract]. https://atcmeetingabstracts.com/abstract/preformed-donor-reactive-t-cells-that-persist-after-abo-desensitization-independently-predict-severe-acute-cellular-rejection-after-living-donor-kidney-transplantation/. Accessed November 24, 2024.

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