Moritz, Michael J, MD

O\u27Brien, Makenzie

Stansbury, Tara

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksResearch Scholars Poster PresentationDoes the Effectiveness of Thymoglobulin asMeasured by T-Cell Depletion Correlate with theIncidence of Acute Rejection Post KidneyTransplant?Makenzie O'BrienTara StansburyMichael J. Moritz MDLehigh Valley Health Network, Michael.Moritz@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/research-scholars-postersThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtO'Brien, M., Stansbury, T., Moritz, M., (2018, 3, August) Does the Effectiveness of Thymoglobulin as Measured by T-Cell DepletionCorrelate with the Incidence of Acute Rejection Post Kidney Transplant? Poster presented at LVHN Research Scholar Program PosterSession, Lehigh Valley Health Network, Allentown, PA.Lehigh Valley Health Network, Allentown, Pennsylvania• Thymoglobulin® is one of two standards for immunosuppression induction agents for renal transplantation and is antibodies derived from rabbits against human T-cell markers including CD2 and CD31.  • CD2 and CD3 are different pan-T cell markers on cell surfaces, quantifiable by flow cytometry3,4.• T lymphocytes are the primary mediator in recognition of foreign antigen so their depletion post transplantation reduces acute cellular graft rejection5. • Grades of kidney graft rejection are defined using the Banff 2017 classification of antibody-mediated rejection (AMR) and acute-cell mediated rejection (ACR)9..• Mean CD2 and CD3 counts before Thymoglobulin® were 1258.5 ± 545.7 and 1162.0 ± 501.9 cells/mm3. • The mean CD2 and CD3 counts after Thymoglobulin® were 10± 33.6 and 8.0± 22.5 in patients with no rejection (N=245) and 16 ±65.6 and 15 ± 60.9 in patients with any level of rejection (N=180).• No association between rejection grade and lymphocyte depletion. • The purpose of this study was to evaluate the relationship between the effectiveness of Thymoglobulin® as measured by T lymphocyte depletion in preventing rejection.• Higher post treatment CD2 and CD3 counts are associated with increased risk of graft rejection in the first post-transplant year• CD2/CD3 counts are not associated with severity of rejection.• Future studies should look into if additional Thymoglobulin® to lower CD2/CD3 counts in patients with higher counts would result in these patients having fewer rejections.BACKGROUNDOBJECTIVEOUTCOMES RESULTSCONCLUSIONSDoes the Effectiveness of Thymoglobulin as Measured by T-Cell Depletion Correlate with the Incidence of Acute Rejection Post Kidney Transplant?Makenzie O’Brien, Tara Stansbury, Michael Moritz, MDMETHODSFigure 1: Break down of worst pathology for each patient. Ascending grades of rejection represent increasing inflammation in the biopsy. • A retrospective review of 425 kidney only transplant recipients from March 2012 to October 2017. • From a complete transplant database the following data was extracted: date of transplant, transplant status, severity of rejection, CD2 and CD3 measurements from the first week and Ascending grades of rejection (Borderline, 1A, 2B, 2A, 2B). Figure 2: Patients with no rejection had lower mean CD2 and CD3 counts than patients with any type of rejectionFigure 3: There was no relationship between mean CD2 or CD3 counts and each grade of rejection.REFERENCESReceived a total of 5mg/kg of Thymoglobulin® over 3 daily doses and 1.25g of methylprednisoloneBlood samples were take to measure CD2 and CD3 countsProtocol biopsies were performed 1,6 and 12 months post-transplantation1. Peddi, V. R., Bryant, M., Roy-Chaudhury, P., Woodle, E. S., First, M. R. (2002). Safety, efficacy, and cost analysis of thymoglobulin induction therapy with intermittent dosing based on cd3 lymphocyte counts in kidney and kidney-pancreas transplant recipients. Transplantation, 73(9), 1514-1518. doi:10.1097/00007890-200205150-000252. CD2 CD2 molecule [Homo sapiens (human)] - Gene - NCBI. (2018, July 8). Retrieved July 17, 2018, from https://www.ncbi.nlm.nih.gov/gene/9143. Chetty, R. and Gatter, K. (1994), CD3: Structure, function, and role of immunostaining in clinical practice. J. Pathol., 173: 303-307. doi:10.1002/path.17117304044. Issa, F., Schiopu, A., & Wood, K. J. (2010). Role of T cells in graft rejection and transplantation tolerance. Expert Review of Clinical Immunology,6(1), 155-169. doi:10.1586/eci.09.645. Haas, M., Loupy, A., Lefaucheur, C., Roufosse, C., Glotz, D., Seron, D., . . . Mengel, M. (2018). The Banff 2017 Kidney Meeting Report: Revised diagnostic criteria for chronic active T cell-mediated rejection, antibody-mediated rejection, and prospects forintegrative endpoints for next-generation clinical trials. American Journal of Transplantation,18(2), 293-307. doi:10.1111/ajt.14625

Does the Effectiveness of Thymoglobulin as Measured by T-Cell Depletion Correlate with the Incidence of Acute Rejection Post Kidney Transplant?

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Does the Effectiveness of Thymoglobulin as Measured by T-Cell Depletion Correlate with the Incidence of Acute Rejection Post Kidney Transplant?

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