Loss of CD28 on Peripheral T Cells Decreases the Risk for Early Acute Rejection after Kidney Transplantation.
Dedeoglu B, Meijers RWJ, et al.PLoS ONE 2016 [Electronic Resource] 11(3): e0150826.
Aims
To determine whether the degree of premature T-cell ageing predicts the risk for early acute allograft rejection (EAR) in kidney transplant recipients.
Interventions
Participants received induction therapy with basiliximab, tacrolimus, mycophenolate mofetil and glucocorticoids. All patients received 50 mg prednisolone twice per day intravenously on days 0–3. Thereafter, 20mg oral prednisolone was started and subsequently tapered to 5mg at month 3.
Participants
222 living donor kidney transplant recipients aged ≥ 18 years.
Outcomes
The primary outcome measured was EAR. The secondary outcome measured was T-cell aging parameters which included the differentiation status of circulating T cells, the relative telomere length and the number of CD31+ naive T cells.
Follow-up
3 months
CET Conclusions
This paper reports a post-hoc analysis from an RCT investigating the role of markers of T-cell ageing on the risk of early acute rejection. The authors report that the differentiation status of circulating T-cells, but not other markers of ageing (including telomere length and CD31+ T-cell population), were associated with risk. These results are interesting, but it should be noted that this is a post-hoc exploratory analysis in a cohort of living donor recipients on a single immunosuppressive regimen. They will require validation in other prospective patient populations. Clinical significance may be limited, but if robust association is confirmed it may possibly allow for a reduction in early immunosuppression in lower-risk patients.
Data analysis
Modified intention-to-treat analysis
Quality notes
Previously assessed as Shuker N, et al. A Randomized Controlled Trial Comparing the Efficacy of Cyp3a5 Genotype-Based With Body-Weight-Based Tacrolimus Dosing After Living Donor Kidney Transplantation.Am J Transplant. 2016 Jul;16(7):2085-96.
Trial registration
Dutch trial registry - NTR 2226; EudraCT 2010-018917-30