Peripheral Blood T- and B-Cells as Predictors of Acute Rejection in Pancreas Transplant Recipients

P. Ventura Aguiar¹, J. Rovira², M. Ramirez-Bajo², E. Bañón-Maneus², N. Hierro², M. Garcia Criado³, M. Cuatrecasas⁴, J. Ferrer⁵, E. Esmatjes⁶, J. Campistol¹, F. Diekmann¹

¹Nephrology and Kidney Transplantation, Hospital Clinic Barcelona, Barcelona, Spain, ²Laboratori Experimental de Nefrologia i Trasplantament, Fundacio Clinic - IDIBAPS, Barcelona, Spain, ³Radiology Department, Hospital Clinic Barcelona, Barcelona, Spain, ⁴Pathology Department, Hospital Clinic Barcelona, Barcelona, Spain, ⁵HepatoBilioPancreatic Surgery Department, Hospital Clinic Barcelona, Barcelona, Spain, ⁶Endocrinology Department, Hospital Clinic Barcelona, Barcelona, Spain

Meeting: 2020 American Transplant Congress

Abstract number: A-256

Keywords: Allorecognition, Mononuclear leukocytes, Pancreas transplantation, Rejection

Session Information

Session Name: Poster Session A: Pancreas and Islet: All Topics

Session Type: Poster Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:00pm

Presentation Time: 3:30pm-4:00pm

Location: Virtual

*Purpose: Pancreas transplantation is associated with a high risk of acute rejection. The effect of peripheral blood mononuclear cells (PBMC) on acute rejection (AR) outcomes has not been explored before.

*Methods: We conducted a single-center prospective longitudinal study including all pancreas transplant recipients from January 2017 to December 2018. Immunosuppression protocol included thymoglobulin. PBMCs were performed at the day of transplant, and afterwards at pancreas biopsy (per protocol or indication). AR was determined if biopsy-proven (BPAR) or clinically suspected.

*Results: A total of 34 pancreas transplants were performed during the study period (SPK 84%, PAK 17%). A total of 13 (38%) patients presented an AR, of which 12 during the first 3 months (92% BPAR). Time from transplantation to AR was 24±10 days, and most were acute T-cell mediated rejection (TCMR: 60%).

Patients who presented an AR during the first 3months had significant higher T-cell frequencies at the day of transplant (D0) (4.38% vs 10.79%; p<.001), both CD4+ T-cells (p<.001) and CD8+ T-cells (p<.01) - Figure 1 A-C. There was a non-significant tendency towards an increase in B-cells (0.52 vs 0.94%; p=.08) and NK cells (0.59% vs 0.95%; p=.09) - Figure 1 D-F. T-cells expressing TCRγδ were increased (3.30 vs 5.58%; p<.05).

T-CD3+ >6% at day of transplantation presented a significant risk for AR during the first 3 months (HR 15.2; 95% CI 1.92-120.3), with a sensitivity and specificity of 91 and 80%, respectively, to predict an AR during this period.

At AR episodes there was a significant increase in B-cell (0.29% vs 1.08%; p<.01) and T-cell frequencies (0.70% vs 3.27%; p<.01). No other differences were found in all other sub-populations analyzed.

*Conclusions: T-cell frequencies in peripheral blood at the day of pancreas transplantation predict the risk for an AR during the first 3 months. Monitoring of PBMCs may provide further information for the development of tailored immunosuppression protocols and of the diagnosis of AR in pancreas transplant recipients.

To cite this abstract in AMA style:

Aguiar PVentura, Rovira J, Ramirez-Bajo M, Bañón-Maneus E, Hierro N, Criado MGarcia, Cuatrecasas M, Ferrer J, Esmatjes E, Campistol J, Diekmann F. Peripheral Blood T- and B-Cells as Predictors of Acute Rejection in Pancreas Transplant Recipients [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/peripheral-blood-t-and-b-cells-as-predictors-of-acute-rejection-in-pancreas-transplant-recipients/. Accessed March 26, 2023.

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