Related Experiment Video

Updated: Oct 15, 2025

Orthotopic Rat Kidney Transplantation: A Novel and Simplified Surgical Approach
09:15

Orthotopic Rat Kidney Transplantation: A Novel and Simplified Surgical Approach

Published on: May 7, 2019

16.2K

The negative impact of T cell-mediated rejection on renal allograft survival in the modern era

Christie Rampersad1, Robert Balshaw2, Ian W Gibson3,4

  • 1Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|October 30, 2021
PubMed

Insights

T cell-mediated rejection (TCMR) impacts many kidney transplant recipients, even with standard immunosuppression. High HLA-DR/DQ mismatch increases TCMR risk and graft loss, highlighting the need for better prevention strategies.

Area of Science:

  • Nephrology
  • Immunology
  • Transplantation

Background:

  • Tacrolimus/mycophenolate-based immunosuppression is standard for kidney transplant recipients.
  • The long-term impact and prevalence of T cell-mediated rejection (TCMR) are not well-defined in this context.

Purpose of the Study:

  • To evaluate the incidence and impact of TCMR in kidney transplant recipients on maintenance therapy.
  • To correlate TCMR events with graft loss and alloimmune risk factors.

Main Methods:

  • Observational study of 775 kidney transplant recipients.
  • Serial histology analysis of kidney biopsies (for-cause and surveillance).
  • Correlation of TCMR events with graft loss, adjusting for covariates like HLA-DR/DQ mismatch, DGF, and ABMR.

Main Results:

  • A ~30% incidence of first TCMR (Banff Borderline or greater) was observed.
  • Persistent or subsequent TCMR occurred in 64% of recipients.
  • Alloimmune risk based on HLA-DR/DQ eplet mismatch correlated with TCMR events and Banff grade.
  • Both first and second TCMR events independently correlated with graft loss (death-censored and all-cause).

Conclusions:

  • A significant proportion of kidney transplant recipients experience TCMR, indicating potential under-immunosuppression.
  • Intermediate and high HLA-DR/DQ molecular mismatch scores are associated with increased TCMR and graft loss.
  • Novel therapeutic agents are needed to improve TCMR prevention and treatment.
Keywords:
T cell-mediated rejectionantibody-mediated rejectionclinical research/practicegraft survivalhistocompatibilityimmunosuppression/immune modulationkidney transplantationpatient survival

More Related Videos

Mouse Kidney Transplantation: Models of Allograft Rejection16:15

Mouse Kidney Transplantation: Models of Allograft Rejection

Published on: October 11, 2014

21.0K
In Vitro and In Vivo Assessment of T, B and Myeloid Cells Suppressive Activity and Humoral Responses from Transplant Recipients18:48

In Vitro and In Vivo Assessment of T, B and Myeloid Cells Suppressive Activity and Humoral Responses from Transplant Recipients

Published on: August 12, 2017

14.5K

Related Concept Videos

Kidney Transplant I: Introduction01:28

Kidney Transplant I: Introduction

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...
80
Kidney Transplant II: Surgical Procedure01:26

Kidney Transplant II: Surgical Procedure

Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
95
Cell-mediated Immune Responses01:40

Cell-mediated Immune Responses

Overview
75.5K
Tissue Transplantation01:24

Tissue Transplantation

Tissue transplantation is a significant medical procedure involving the transfer of cells, tissues, or organs from a donor to a recipient, with the primary aim of restoring lost functions. This procedure is crucial in treating a broad spectrum of diseases, including kidney diseases, liver failure, heart disease, and certain types of cancers.
The Biology of Tissue Transplantation
The biology of tissue transplantation hinges on the Major Histocompatibility Complex (MHC) molecules. These molecules...
587
Kidney Transplant III: Nursing Management01:16

Kidney Transplant III: Nursing Management

Postoperative Nursing Management for Kidney Transplant PatientsPostoperative nursing management care includes monitoring the surgical site, encouraging early movement, and promoting lung health through breathing exercises. Nurses also administer prescribed medications like H2-blockers, such as famotidine, or proton pump inhibitors, like omeprazole, to help prevent gastrointestinal ulcers and bleeding. Fungal infections in the mouth and bladder can result from immunosuppressive and antibiotic...
101
Acute Kidney Injury II: Pathophysiology01:29

Acute Kidney Injury II: Pathophysiology

Acute kidney injury (AKI) causes are categorized into three primary categories based on the location of the injury: prerenal, intrarenal (or intrinsic), and postrenal causes. This classification guides clinical management and illustrates how different pathways can impair kidney function.Etiology and Pathophysiology of Acute Kidney Injury1. Prerenal causesEtiology: Prerenal Acute Kidney Injury, the most common type, occurs when reduced blood flow to the kidneys decreases filtration capacity...
202