Donor-Reactive T-cell Responses after HLA-Identical Living-Related Kidney Transplantation

Kidney transplantation is the preferred treatment of choice for almost all categories of patients with end-stage-renal disease (ESRD) including those with hypertension, glomerulonephritis, diabetes mellitus and genetic causes as polycystic renal disease. Transplanted patients will live approximately 10-15 years longer than patients that remain on dialysis. In light of the increased donor shortage and the increasing waiting time, the number of kidney transplants from living donors enormously increased during the last decade. Complete matching for major Human Leucocyte Antigen (HLA) molecules between donor and recipients is preferable, but due to the high degree of polymorphism of HLA, only some recipients with a suitable living-related sibling donor receive a fully HLA-identical donor kidney

Donor-reactive cytokine profiles after HLA-identical living-related kidney transplantation

Background. After HLA-identical living-related (LR) kidney transplantation, only non-HLA antigen mismatches between donor and recipient may exist. We questioned whether donor-reactive responses against non-HLA antigens could be found after HLA-identical LR kidney transplantation, and wondered whether donor reactivity in the HLA-identical setting was different from the HLA-mismatched setting during immunological quiescence. Healthy individuals served as controls. Methods. Elispot assays were performed to determine the number of alloreactive IFN-γ-producing cells (pc), IL-10 pc, granzyme B (GrB) pc and IL-13 pc from peripheral blood mononuclear cells (PBMC) of HLA-identical, HLA-mismatched LR kidney transplant recipients and healthy individuals. Results. The frequency of alloreactive IFN-γ pc, IL-13 pc and GrB pc was higher in healthy individuals compared to both transplant patient groups. In the HLA-identical group, significantly higher numbers of donor-reactive IL-10 pc were found compared to their autologous control. These frequencies were also higher compared to the HLA-mismatched and healthy control group. The number of donor-reactive GrB pc was higher in the HLA-mismatched group than in the HLA-identical group. Donor-reactive IFN-γ pc and IL-13 pc were comparable in both transplant groups. Conclusions. In recipients of HLA-identical LR kidney transplant, high donor-reactive IL-10 pc, in combination with low donor-reactive IFN-γ pc, IL-13 pc and GrB pc, suggests active downregulation of reactivity against non-HLA molecules

Stable T-cell reactivity after successful tapering of azathioprine in HLA-identical living-related kidney transplant recipients despite minor histocompatibility antigen mismatches

Background. Human leukocyte antigen (HLA)-identical living-related (LR) kidney transplant recipients often receive the standard regimen of immunosuppression. We wondered whether these patients should be exposed to the side effects of these drugs any longer. Safe tapering of immunosuppression should not result in rejection and high donor-directed T-cell responses. In the present study, we investigated the effect of tapering azathioprine (AZA) on T-cell reactivity. Methods. Fifteen HLA-identical LR kidney transplant recipients receiving a median of 150 mg/day AZA and 5-10 mg/day prednisone were tapered to a median of 50 mg/day AZA. Donor-, third-party and tetanus toxoid (TET)-reactivity were determined in interferon (IFN)-γ and interleukin (IL)-13 Elispot assays, which reflect the T-helper (Th)1 and T-helper (Th)2 response. Results. After the tapering of AZA, none of the patients developed acute rejection and the renal function remained stable, even at 1-year follow-up. The frequency of donor-specific IFN-γ and IL-13 producing cells (pc) was low. Tapering of AZA did not influence the frequency of both IFN-γ and IL-13 pc. Also, the reactivity against third-party cells and TET remained unchanged. Conclusions. The AZA-dose can be safely reduced in recipients of an HLA-identical LR kidney transplant without affecting kidney function and without increasing T-cell responses directed against donor or other antigens