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A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
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Interferon Gamma ELISPOT Testing as a Risk-Stratifying Biomarker for Kidney Transplant Injury: Results From the

D E Hricik1, J Augustine1, P Nickerson2

  • 1Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH.

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|August 1, 2015
PubMed
Summary

Pre-transplant T cell assays (IFNγELISPOT) predict kidney transplant outcomes, but only if rabbit anti-thymocyte globulin (ATG) is not used. ATG may benefit patients with high donor-reactive T cells.

Keywords:
Clinical research/practiceT cell biologyglomerular filtration rate (GFR)immunobiologykidney transplantation/nephrologyrejection: acuterisk assessment/risk stratificationtranslational research/science

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Area of Science:

  • Immunology
  • Transplantation
  • Nephrology

Background:

  • Quantifying donor-reactive memory T cells using interferon gamma enzyme-linked immunosorbent spot assay (IFNγELISPOT) may predict kidney transplant outcomes.
  • Previous studies suggest a link between pre-transplant T cell responses and post-transplant allograft injury.

Purpose of the Study:

  • To analyze the correlation between pre-transplant IFNγELISPOT results and kidney transplant outcomes.
  • To investigate the influence of immunosuppression, specifically rabbit anti-thymocyte globulin (ATG), on this correlation.

Main Methods:

  • Analysis of data from the multicenter, Clinical Trials in Organ Transplantation-01 observational study.
  • Included 176 primary kidney transplant recipients with available pre-transplant IFNγELISPOT results.
  • Examined outcomes including acute rejection (AR) and estimated glomerular filtration rate (eGFR) at 6 and 12 months, stratified by ATG use.

Main Results:

  • Pre-transplant IFNγELISPOT positivity did not correlate with AR or eGFR in the overall cohort.
  • In the no-ATG subgroup, IFNγELISPOT-negative subjects had significantly higher eGFRs than IFNγELISPOT-positive subjects at 6 and 12 months.
  • This correlation was absent in subjects who received ATG induction, indicating ATG as a potential modifier.

Conclusions:

  • Pre-transplant IFNγELISPOT positivity is associated with lower post-transplant eGFR, but this association is dependent on the absence of ATG induction.
  • ATG induction may mitigate the negative impact of high donor-reactive T cell frequencies on kidney transplant outcomes.
  • Further controlled studies are warranted to confirm the benefit of ATG in specific patient populations identified by T cell assays.