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Increased Pre-Transplant Rejection-Risk Measured with Allospecific T-Cells Predicts Delayed Immunosuppression Minimization in Children with Intestine Transplantation.

K. Soltys, C. Ashokkumar, G. Mazariegos, G. Bond, M. Ningappa, A. Khanna, A. Ganoza, Q. Sun, R. Sindhi.

Pediatric Abdominal Transplant, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA.

Meeting: 2018 American Transplant Congress

Abstract number: 82

Keywords: Immunosuppression, Intestinal transplantation, Pediatric, Rejection

Session Information

Session Name: Concurrent Session: Small Bowel: All Topics

Session Type: Concurrent Session

Date: Sunday, June 3, 2018

Session Time: 2:30pm-4:00pm

 Presentation Time: 2:30pm-2:42pm

Location: Room 210

BACKGROUND: Allospecific CD154+T-cytotoxic memory cells (CD154+TcM) are used clinically to predict acute cellular rejection (ACR) after intestine transplantation (ITx) in children <21 years old within the 60-day post-sampling period.

PURPOSE: To determine whether increased pre-transplant rejection-risk measured by CD154+TcM predicts increased immunosuppression with tacrolimus and steroids in 60-month follow-up in children with ITx who were enrolled in in pivotal studies of this test system (National Clinical Trial 1163578). METHODS: The clinical course of 22 children, in whom rejection-risk was measured with the immunoreactivity index (IR) of CD154+TcM before ITx was evaluated for 60 months after ITx. An immunoreactivity index of 1.23 or greater implies increased rejection-risk, as described previously. Tacrolimus whole blood concentrations and prednisone doses were recorded at 12-monthly intervals until month 60, and compared between children at increased and decreased rejection-risk. Immunosuppression management was based on clinical protocols.

RESULTS: Median age was 2 years (range 0.7-15). The distribution of male: female gender was 13: 9, and Caucasian: non-caucasian race was 11: 11. Ten children demonstrated increased rejection-risk and 12 children demonstrated decreased rejection-risk before ITx. In between-group comparisons over a 60-month follow-up period, children with increased rejection-risk demonstrated 1) significantly shorter median time to the first biopsy-proven acute cellular rejection event (22 vs 281 days, p=0.033, K-M test), 2) significantly lower 5-year rejection-free survival (8% vs 40%, p=0.033, K-M test) and 3) higher mean (+/-SEM) tacrolimus whole blood, which achieved significance at 12 (9.3+/-0.9 vs 4.5+/-0.7 ng/ml, p-value=0.001) 48 (6.5+/-0.9 vs 3.3+/-0.4 ng/ml, p-value=0.01) and 60 months (6.0+/-0.8 vs 3.2+/-0.3 ng/ml, p-value=0.02) after ITx. No differences were seen in steroid use or steroid doses between the two groups.

CONCLUSIONS: Increased rejection-risk measured with allospecific CD154+T-cytotoxic memory cells before intestine transplantation predicts delayed minimization of tacrolimus in children. Therefore, pre-transplant rejection-risk assessment may be a useful adjunct to immunosuppression management after pediatric ITx.

CITATION INFORMATION: Soltys K., Ashokkumar C., Mazariegos G., Bond G., Ningappa M., Khanna A., Ganoza A., Sun Q., Sindhi R. Increased Pre-Transplant Rejection-Risk Measured with Allospecific T-Cells Predicts Delayed Immunosuppression Minimization in Children with Intestine Transplantation. Am J Transplant. 2017;17 (suppl 3).

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To cite this abstract in AMA style:

Soltys K, Ashokkumar C, Mazariegos G, Bond G, Ningappa M, Khanna A, Ganoza A, Sun Q, Sindhi R. Increased Pre-Transplant Rejection-Risk Measured with Allospecific T-Cells Predicts Delayed Immunosuppression Minimization in Children with Intestine Transplantation. [abstract]. https://atcmeetingabstracts.com/abstract/increased-pre-transplant-rejection-risk-measured-with-allospecific-t-cells-predicts-delayed-immunosuppression-minimization-in-children-with-intestine-transplantation/. Accessed June 6, 2025.

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