Online Programm

Einleitung und Fragestellung / Introduction and Background

Alloreactive T-cells have been suggested to impact allograft outcome due to a higher incidence of acute cellular rejection. Knowledge on risk factors for the development of preformed and de-novo alloreactive T-cells, however, remains scarce.

Methodik / Methods

We analyzed 327 primary kidney transplant recipients (KTRs) transplanted from 2008 to 2014. KTRs were grouped regarding the pretransplant alloreactive T-cells. KTRs without pretransplant alloreactive T-cells were grouped regarding the development of de-novo alloreactive T-cells. Samples were collected pretransplantation, at +1, +2, +3 months posttransplantation, and alloreactive T-cells were measured by interferon-γ Elispot assay.

Ergebnisse und Schlussfolgerungen / Results and Conclusions

Among 327 KTRs, 107 KTRs (33%) showed pretransplant alloreactive T-cells. Risk factors for the presence of preformed alloreactive T-cells included older age, diabetes, and prior malignancies (p<0.05). Preformed alloreactive T-cells were associated with a higher incidence of delayed graft function (p=0.017). Among 220 KTRs without alloreactive T-cells pretransplantation, 31 KTRs (14%) showed de-novo alloreactive T-cells. Risk factors included female sex and prior malignancies (p<0.05). KTRs with preformed/de-novo alloreactive T-cells showed inferior patient survival, allograft survival, and allograft function, a higher incidence of acute cellular rejections, sepsis, and posttransplant malignancies (p<0.05).

The presence of alloreactive T-cells strongly impacts patient and allograft outcomes. Insulin therapy, and treated or undetected malignancies may lead to presensitization with preformed alloreactive T-cells. Caution should be taken in KTRs with alloreactive T-cells with regards to minimizing immunosuppression.