Relationship between antithymocyte globulin, T cell phenotypes, and clinical outcomes in pediatric kidney transplantation
Autor: | Linda Stempora, Hui-Jie Lee, Minnie M. Sarwal, Allan D. Kirk, Cliburn Chan, Robert B. Ettenger, Barry L. Warshaw, Mark A. Robien, Congwen Zhao, Eileen Tsai Chambers, Olivia M. Martinez, Elaine F. Reed, Brian I. Shaw, Meghan H. Pearl, Paul C. Grimm |
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Rok vydání: | 2019 |
Předmět: |
Adult
Graft Rejection Kidney Disease pediatrics translational research/science T cell Renal and urogenital Viremia kidney transplantation/nephrology immunosuppression/immune modulation 030230 surgery clinical research/practice Medical and Health Sciences Article 03 medical and health sciences 0302 clinical medicine Immune system Rare Diseases Clinical Research Biopsy Immunology and Allergy Medicine Cytotoxic T cell Humans Pharmacology (medical) Child Kidney transplantation Antilymphocyte Serum Pediatric Transplantation medicine.diagnostic_test business.industry rabbit antithymocyte globulin [immunosuppressant - polyclonal preparations] Inflammatory and immune system immune regulation Graft Survival Organ Transplantation medicine.disease Kidney Transplantation medicine.anatomical_structure Good Health and Well Being Phenotype Concomitant Immunology Surgery Patient Safety business CD8 Immunosuppressive Agents |
Zdroj: | Am J Transplant American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, vol 21, iss 2 |
ISSN: | 1600-6143 |
Popis: | Depletional induction using anti-thymocyte globulin (ATG) reduces rates of acute rejection in adult kidney transplant recipients, yet little is known about its effects in children. Using a longitudinal cohort of 103 patients in the Immune Development in Pediatric Transplant (IMPACT) study, we compared T cell phenotypes after ATG or non-ATG induction. We examined the effects of ATG on the early clinical outcomes of alloimmune events (development of de novo donor specific antibody and/or biopsy proven rejection) and infection events (viremia/viral infections). Long-term patient and graft outcomes were examined using the Scientific Registry of Transplant Recipients. After ATG induction, although absolute counts of CD4 and CD8 T cells were lower, patients had higher percentages of CD4 and CD8 memory T cells with a concomitant decrease in frequency of naïve T cells compared to non-ATG induction. In adjusted and unadjusted models, ATG induction was associated with increased early event-free survival, with no difference in long-term patient or allograft survival. Decreased CD4+ naïve and increased CD4+ effector memory T cell frequencies were associated with improved clinical outcomes. Though immunologic parameters are drastically altered with ATG induction, long term clinical benefits remain unclear in pediatric patients. |
Databáze: | OpenAIRE |
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