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
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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