Introduction Immune-mediated rejection remains the most important cause of graft failure. Recently, a newly identified CD4+ T cell subset, Th17, distinct from Th1 or Th2, was characterized by the production of interleukin-17A (IL-17A). It has been shown that Th17 expression was markedly increased in inflamed transplants. There is evidence that a low inflammatory response is leading to better long-term outcomes. In a retrospective analysis we determined IL-17A production in setup of two different immunosuppressive regimens: ATG-F induction vs. triple drug in comparison to a sensitive inflammatory marker kynurenine.

Material and Methods By using a commercial ELISA (Cusabio™) we determined IL-17A and with a colorimetric assay kynurenine (9th-11th day post transplantation; 50% f/50%m). In gr.I (n=20, ATG-F-induction; CsA, MMF, MP) and gr.II (n=20, CsA, MMF, MP). A third group III (n=20) with rejection episodes (BPAR) in different stages were used for comparison reasons. All patients with immediate graft function.

Results There was a significant difference between the three groups. For IL-17 we estimated 21,2+3 pg/ml (gr.I); 116+45 pg/ml (gr.II) and 271+87 pg/ml (gr.III). Values for kynurenin were 5,4+2,5 nmol/ml (I), 6,9+3,2 (II); 12,3+ 4,9 (III). There was a clear benefit concerning a lower inflammatory response in the group with induction treatment.

Conclusion The significant difference between the IL-17 production in induction treated patients could be one explanation for the better long term outcome. ATG is leading to a lower inflammatory potential proven also by kynurenine measurement. There is evidence that the low IL-17 and low kynurenin production predicts the better outcome.

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