Date: Saturday, May 2, 2015
Session Name: Poster Session A: Liver: Immunosuppression and Rejection
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Exhibit Hall E
Background: Allospecific CD154+T-cytotoxic memory (CD154+TcM) have completed investigational evaluation as predictors of acute cellular rejection in children with LTx or ITx.
Purpose: To evaluate CD154+TcM** as a laboratory developed test for prediction of clinical response to treatment selected on the basis of simultaneous biopsy or clinical assessment.
Methods: Single blood samples were assayed for allospecific CD154+TcM with flow cytometry in 35 children with LTx and ITx. In this index-based test system, immunoreactivity index (IR) thresholds of ≥1.1 and <1.1 predict, respectively, increased and decreased risk of rejection within 60 days after testing. Clinical rejector or non-rejector status assessed simultaneously with biopsy or clinical/laboratory parameters was recorded. Rejector and non-rejector status assessed with CD154+TcM or clinical procedures were evaluated for the accuracy with which the outcome of treatment in the following 60 days concurred with initial assessment using either approach.
Results: Eleven of 14 biopsy-proven rejectors demonstrated increased rejection-risk with CD154+TcM (test sensitivity 78.6%). Twenty of 21 non-rejectors, 15 of whom were biopsy-proven, demonstrated decreased rejection-risk (test specificity 91.7%). Increased immunosuppression following biopsy-proven rejection was reversed in two of 14 rejectors with IR values of 0.74 and 0.34 within 1 and 3 weeks, respectively. Reasons were viral pneumonia requiring intubation, and viral enteritis and dehydration, respectively. Both patients remain rejection free. A biopsy-proven non-rejector with IR 2.4 developed erythema of the intestine allograft mucosa and was found to have rejection on emergent biopsy two days later, which responded to steroids. Clinical assessment of rejector and non-rejector status aided by biopsy led to correct treatment choices in 32/25 children (accuracy 91.4%). Assessment of rejection-risk with CD154+TcM concurred with final treatment in 34/35 children (accuracy 97.1%).
Conclusions: Adjunctive use of allospecific CD154+T-cytotoxic memory cells can enhance clinical rejection-risk assessment, treatment selection and outcomes in children with liver or intestine transplantation.
**USP 8426146, Assignee University of Pittsburgh, Licensee Plexision, Inc. Pittsburgh
To cite this abstract in AMA style:Soltys K, Bond G, Mazariegos G, Ashokkumar C, Dirling K, O'Toole L, Kachmar P, Hartle T, Martin D, Trautz C, Sindhi R. Clinical Utility of Allospecific CD154+T-Cells in Children With Liver Or Intestine Transplantation (LTx, ITx) [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/clinical-utility-of-allospecific-cd154t-cells-in-children-with-liver-or-intestine-transplantation-ltx-itx/. Accessed January 16, 2019.
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