Although renal transplantation using expanded criteria donors has become a common practice, immune responses related to immunosenescence in those kidney allografts have not been studied yet in humans. We performed a retrospective molecular analysis of the T cell immune response in 43 kidney biopsies from patients with acute T-cell mediated rejection including 25 from recipients engrafted with a kidney from expanded criteria donor and 18 from recipients grafted with optimal kidney allograft. The clinical, transplant and acute T-cell mediated rejection characteristics of both groups were similar at baseline. The expression of RORγt, Il-17 and T-bet mRNA was significantly higher in the elderly than in the optimal group (p=0.02, p=0.036 and p=0.01, respectively). Foxp3 mRNA levels were significantly higher in elderly patients experiencing successful acute T-cell mediated rejection reversal (p=0.03). The presence of IL-17 mRNA was strongly associated with non-successful reversal in elderly patients (p=0.008). Patients with mRNA IL17 expression detection and low mRNA Foxp3 expression experiencing significantly more treatment failure (87.5%) than patients with no mRNA IL17 expression and/or high mRNA Foxp3 (26.7%; p=0.017). Our study suggests that Th17 pathway is involved in pathogenesis and prognosis of acute T-cell mediated rejection in recipients of ECD allograft.

« Back to 2015 American Transplant Congress