Histopathological analysis of infiltrating T cell subsets in acute T cell-mediated rejection in the kidney transplant
Histopathological analysis of infiltrating T cell subsets in acute T cell-mediated rejection in the kidney transplant作者机构：Tregs and HLA Research Force and Renal Medicine DepartmentSingapore General Hospital Tregs and HLA Research Force and Department of PathologyNational University Hospital Tregs and HLA Research Force and Yong Loo Lin School of MedicineNational University of Singapore Department of Pathology and Laboratory MedicineKK Women’s and Children’s Hospital Department of Pathology Singapore General Hospital Centre for Quantitative MedicineDuke-NUS Graduate Medical School
出 版 物：《World Journal of Transplantation》 (世界移植杂志)
年 卷 期：2017年第7卷第4期
页 面：222-234页
学科分类：10[医学]
基 金：National Kidney Foundation Singapore,No.NKFRC/2008/07/22 the Medicine Academic Clinical Program(a Sing Health-Duke/National University of Singapore Joint Partnership) the Khoo Scholar Programme(Duke/National University of Singapore)
主 题：Acute T cell-mediated rejection in the kidney transplant Banff classification Cytotoxic T cell Regulatory T cell Th17 cell
摘 要：AIM To compare the differential immune T cell subset com-position in patients with acute T cell-mediated rejection in the kidney transplant with subset composition in the absence of rejection, and to explore the association of their respective immune profiles with kidney transplant outcomes.METHODS A pilot cross-sectional histopathological analysis of the immune infiltrate was performed using immunohistochemistry in a cohort of 14 patients with acute T cellmediated rejection in the kidney transplant and 7 kidney transplant patients with no rejection subjected to biopsy to investigate acute kidney transplant dysfunction. All patients were recruited consecutively from 2012 to 2014 at the Singapore General Hospital. Association of the immune infiltrates with kidney transplant outcomes at up to 54 mo of follow up was also explored prospectively.RESULTS In a comparison to the absence of rejection, acute T cell-mediated rejection in the kidney transplant was characterised by numerical dominance of cytotoxic T lymphocytes over Foxp3^+ regulatory T cells, but did not reach statistical significance owing to the small sample size in our pilot study. There was no obvious difference in absolute numbers of infiltrating cytotoxic T lymphocytes, Foxp3^+ regulatory T cells and Th17 cells between the two patient groups when quantified separately. Our exploratory analysis on associations of T cell subset quantifications with kidney transplant outcomes revealed that the degree of Th17 cell infiltration was significantly associated with shorter time to doubling of creatinine and shorter time to transplant loss.CONCLUSION Although this was a small pilot study, results support our suspicion that in kidney transplant patients the immune balance in acute T cell-mediated rejection is tilted towards the pro-rejection forces and prompt larger and more sophisticated studies.
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