title: Panel of reactive T cells as a measurement of primed cellular alloimmunity in kidney transplant candidates.
abstract: Pretransplantation panel reactive antibody (PRA) testing assesses posttransplantation risk for antibody-mediated graft injury. It was postulated analogously that screening for effector/memory alloreactive T cells by "panel of reactive T cells" (PRT) using IFN-gamma enzyme-linked immunosorbent spot assays would evaluate independently cellular alloimmunity in transplant candidates. Peripheral blood lymphocytes from 41 hemodialysis patients who were awaiting first renal transplants were tested against a panel of allogeneic stimulator cells. Positive assays were defined arbitrarily as >25 spots/300,000 peripheral blood lymphocytes, and positive PRT was defined as when the responder reacted to 40 or 75% (PRT-75) of the stimulators. Seventeen percent of patients were PRT-75+, whereas 32% were PRA+. Twelve percent of the cohort was PRT-75+/PRA-, and only 5% of the patients were PRA+/PRT-75+, indicating that T cell alloreactivity did not routinely imply B cell sensitization and vice versa. PRT-75+ patients were more likely to be younger (<55 yr) and black. In contrast, a positive PRA was significantly associated with female gender but not race or age. Pretransplantation screening of cellular alloimmunity by enzyme-linked immunosorbent spot-based PRT detects a subset of hemodialysis patients who differ from those that are PRA+. Preliminary correlations with posttransplantation outcome in seven recipients suggest that PRT screening has the potential to aid in risk assessment in renal transplant candidates.
authors.affiliation: Department of Nephrology and Hypertension, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
authors.forename: Emilio D
authors.initials: ED
authors.lastname: Poggio
authors.forename: Michael
authors.initials: M
authors.lastname: Clemente
authors.forename: Donald E
authors.initials: DE
authors.lastname: Hricik
authors.forename: Peter S
authors.initials: PS
authors.lastname: Heeger
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006084:Graft Rejection; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D007518:Isoantibodies / Q000378:metabolism*; D007676:Kidney Failure, Chronic / Q000276:immunology* / Q000378:metabolism* / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D013601:T-Lymphocytes / Q000276:immunology*
chemical_list: D007518:Isoantibodies