Viral-Specific Cytotoxic T-Cell Responses in Hla-Sensitized Kidney Transplant Patients Maintained on Everolimus and Low Dose Tacrolimus

R. Zhang¹, S. Ge¹, M. Chu¹, J. Kahwaji², A. Karasyov¹, D. Lovato¹, A. Vo², J. Choi², M. Toyoda¹, S. Jordan²

¹Transplant Immunology Laboratory, Cedars Sinai Medical Center, Los Angeles, CA, ²Comprehensive Transplant Center, Cedars Sinai Medical Center, Los Angeles, CA

Meeting: 2022 American Transplant Congress

Abstract number: 1688

Keywords: Highly-sensitized, Immunosuppression, Infection, Kidney transplantation

Topic: Clinical Science » Kidney » 38 - Kidney Immunosuppression: Novel Regimens and Drug Minimization

Session Information

Session Name: Kidney Immunosuppression: Novel Regimens and Drug Minimization

Session Type: Poster Abstract

Date: Tuesday, June 7, 2022

Session Time: 7:00pm-8:00pm

Presentation Time: 7:00pm-8:00pm

Location: Hynes Halls C & D

*Purpose: Post-transplant immunosuppression with “everolimus + reduced dose tacrolimus” (Ev + Tac_low) is reported to reduce the risk of viral infections compared to standard doses of “tacrolimus + mycophenolate mofetil” (Tac + MMF). HLA-sensitized (HS) patients are at higher risk for infectious complications due to increased immunosuppression. Here we evaluated infections and viral immunity in HS patients maintained on Ev + Tac_low v. Tac + MMF transplanted after desensitization.

*Methods: HS kidney transplant patients received desensitization with IVIg + rituximab + PLEX and when transplanted, induction with Campath. Patients received Ev + Tac_low (#19) or Tac + MMF (#403). All were monitored pre- and post-transplant for viremia (CMV, BK, and EBV) by PCR. CMV & EBV-specific cytotoxic T-cells (CMV-Tc and EBV-Tc) were evaluated by intracellular cytokine flow cytometry. DSA levels were assessed by Luminex for selected patients in both groups.

*Results: CMV, EBV and BKV viremia rates were similar in Ev + Tac_low v. Tac + MMF patients. No patient in either group developed BKAN or PTLD. CMV- & EBV-Tc decreased significantly after alemtuzumab induction but returned to pre-treatment levels 1-2 months post-transplant in most patients. Development of de novo DSA (dnDSA) was similar in both groups as were patient and graft survival and graft rejection rates.

*Conclusions: CMV-Tc, EBV-Tc, and viremia levels were similar in Ev + Tac_low and Tac + MMF patients, suggesting no benefit of Ev + Tac_low v. Tac + MMF in enhancing viral-specific Tc effector functions in highly-HLA sensitized kidney transplant patients.

To cite this abstract in AMA style:

Zhang R, Ge S, Chu M, Kahwaji J, Karasyov A, Lovato D, Vo A, Choi J, Toyoda M, Jordan S. Viral-Specific Cytotoxic T-Cell Responses in Hla-Sensitized Kidney Transplant Patients Maintained on Everolimus and Low Dose Tacrolimus [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/viral-specific-cytotoxic-t-cell-responses-in-hla-sensitized-kidney-transplant-patients-maintained-on-everolimus-and-low-dose-tacrolimus/. Accessed May 30, 2025.

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