Molecular and Functional Immune Assays as Non-Invasive Diagnostic Tools to Assess the Risk of Acute Subclinical Rejection After Kidney Transplantation
1Kidney Transplant Unit, Bellvitge University Hospital, Barcelona, CAT, Spain
2Department of Transplant Surgery, UCSF, San Francisco, CA.
Meeting: 2015 American Transplant Congress
Abstract number: C266
Keywords: Kidney transplantation, Rejection, Renal dysfunction, T cells
Session Information
Session Name: Poster Session C: Translational Biomarkers and Immune Monitoring
Session Type: Poster Session
Date: Monday, May 4, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Subclinical allograft rejection (sc-AR) is still a main cause of allograft loss that can only be assessed through invasive surveillance biopsies. We sought to investigate whether the combination of novel non-invasive biomarkers at the molecular and immune functional level could help identifying patients at risk of sc-AR after kidney transplantation.
Methods:
We combined the assessment of the donor-specific IFN-γ T-cell ELISPOT with a highly sensitive and specific transcriptional biomarker test in peripheral blood samples predicting kidney solid organ clinical rejection (KSORT) using qPCR, in a group of 75 consecutive kidney transplant patients at the time of 6-month protocol biopsies.
Results:
All patients received CNI-based IMS and either rATG or basilimab. 22/75(29%) patients showed histological lesions of sc-AR (18 TCMR, 5 ABMR and 1 mix TCMR/ABMR), 22 showed borderline (BL) lesions and 31 a stable (STA) parenchyma. The KSORT showed a high-risk (HR) and low-risk (LR) scores in 23% and 77% patients, respectively. The T-cell ELISPOT was positive in 41% of patients, whereas negative in 59%. 82% and 70% patients with BL lesions showed a LR KSORT and negative T-cell Elispot, respectively. The KSORT correctly classified as LR 98%) STA and as HR 70% sc-AR (p<0.001), further discriminating as HR all (100%) sc-ABMR and 62.5% sc-TCMR (p<0.001). The d-s T-cell ELISPOT accurately ruled out the presence of sc-TCMR in 72% and predicted its presence in 83.3% (p<0,001), whereas it did not discriminate patients with sc-ABMR (p=NS). transplant recipients with a positive T-cell ELISPOT showed significantly higher tubulitis and interstitium infiltrates than patients with negative a ELISPOT test, whereas those patients with a positive KSORT did show both higher tubulitis (at) and interstium infiltrates (ai) as well as higher glomerulitis (ag) and peritubular capillarities (ptc).
Conclusions:
Combining a non-invasive molecular and functional cellular immune assay allows an accurate identification of patients developing sc-AR, dissecting the main alloimmune effector mechanism responsible of it.
To cite this abstract in AMA style:
Bestard O, Crespo E, Sigdel T, Roedder S, Ng Y, Cruzado J, Lúcia M, Hsieh S-C, Tran T, Grinyó J, Sarwal M. Molecular and Functional Immune Assays as Non-Invasive Diagnostic Tools to Assess the Risk of Acute Subclinical Rejection After Kidney Transplantation [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/molecular-and-functional-immune-assays-as-non-invasive-diagnostic-tools-to-assess-the-risk-of-acute-subclinical-rejection-after-kidney-transplantation/. Accessed May 13, 2025.« Back to 2015 American Transplant Congress