Fiche publication
Date publication
mai 2016
Journal
Kidney international
Auteurs
Membres identifiés du Cancéropôle Est :
Pr DUCLOUX Didier
,
Mme LAHEURTE Caroline
Tous les auteurs :
Bamoulid J, Courivaud C, Crepin T, Carron C, Gaiffe E, Roubiou C, Laheurte C, Moulin B, Frimat L, Rieu P, Mousson C, Durrbach A, Heng AE, Rebibou JM, Saas P, Ducloux D
Lien Pubmed
Résumé
Lack of clear identification of patients at high risk of acute rejection hampers the ability to individualize immunosuppressive therapy. Here we studied whether thymic function may predict acute rejection in antithymocyte globulin (ATG)-treated renal transplant recipients in 482 patients prospectively studied during the first year post-transplant of which 86 patients experienced acute rejection. Only CD45RA(+)CD31(+)CD4(+) T cell (recent thymic emigrant [RTE]) frequency (RTE%) was marginally associated with acute rejection in the whole population. This T-cell subset accounts for 26% of CD4(+) T cells. Pretransplant RTE% was significantly associated with acute rejection in ATG-treated patients (hazard ratio, 1.04; 95% confidence interval, 1.01-1.08) for each increased percent in RTE/CD4(+) T cells), but not in anti-CD25 monoclonal (αCD25 mAb)-treated patients. Acute rejection was significantly more frequent in ATG-treated patients with high pretransplant RTE% (31.2% vs. 16.4%) or absolute number of RTE/mm(3) (31.7 vs. 16.1). This difference was not found in αCD25 monclonal antibody-treated patients. Highest values of both RTE% (>31%, hazard ratio, 2.50; 95% confidence interval, 1.09-5.74) and RTE/mm(3) (>200/mm(3), hazard ratio, 3.71; 95% confidence interval, 1.59-8.70) were predictive of acute rejection in ATG-treated patients but not in patients having received αCD25 monoclonal antibody). Results were confirmed in a retrospective cohort using T-cell receptor excision circle levels as a marker of thymic function. Thus, pretransplant thymic function predicts acute rejection in ATG-treated patients.
Mots clés
Acute Disease, Adult, Aged, Antigens, CD31, immunology, Antigens, CD45, immunology, Antilymphocyte Serum, adverse effects, CD4-Positive T-Lymphocytes, immunology, Female, France, Graft Rejection, diagnosis, Humans, Immunosuppressive Agents, adverse effects, Kidney Transplantation, adverse effects, Male, Middle Aged, Phenotype, Predictive Value of Tests, Prospective Studies, Receptors, Antigen, T-Cell, genetics, Reproducibility of Results, Retrospective Studies, Risk Assessment, Risk Factors, Thymus Gland, immunology, Time Factors, Treatment Outcome
Référence
Kidney Int.. 2016 May;89(5):1136-43
