title: Allospecific CD154+ T-cytotoxic memory cells identify recipients experiencing acute cellular rejection after renal transplantation.
abstract: BACKGROUND
  The novel, recently described allo (antigen)-specific CD154+T cells were evaluated for their association with acute cellular rejection (ACR) in 43 adult renal transplant recipients receiving steroid-free tacrolimus after alemtuzumab induction.
  
  
  METHODS
  Single blood samples corresponding to "for cause" allograft biopsies were assayed for CD154+naive or memory T-helper or T-cytotoxic cells in 16-hr mixed leukocyte reaction.
  
  
  RESULTS
  Intra- and interassay variation was less than 10% for a variety of conditions. In logistic regression, leave-one-out cross-validation, and receiver-operating characteristic analyses, the rejection-risk threshold of allospecific CD154+T-cytotoxic memory cells (TcMs) associated best with biopsy-proven ACR with a sensitivity/specificity of 88% in 32 of 43 subjects. Sensitivity/specificity of 100%/88% was replicated in blinded prediction in the remaining 11 subjects. Allospecific CD154+TcM correlated inversely with CTLA4+TcM (Spearman r=-0.358, P=0.029) and increased significantly with increasing histological severity of ACR (P=2.99E-05, Kruskall-Wallis).
  
  
  CONCLUSIONS
  The strong association between ACR and allospecific CD154+TcM may be useful in minimizing protocol biopsies among recipients at reduced rejection risk.
authors: Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, PA, USA.
authors: Chethan
authors: C
authors: Ashokkumar
authors: Ron
authors: R
authors: Shapiro
authors: Henkie
authors: H
authors: Tan
authors: Mylarappa
authors: M
authors: Ningappa
authors: Beth
authors: B
authors: Elinoff
authors: Sheila
authors: S
authors: Fedorek
authors: Qing
authors: Q
authors: Sun
authors: Brandon W
authors: BW
authors: Higgs
authors: Paramjeet
authors: P
authors: Randhawa
authors: Abhinav
authors: A
authors: Humar
authors: Rakesh
authors: R
authors: Sindhi
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D023201:CD40 Ligand / Q000378:metabolism*; D005260:Female; D006084:Graft Rejection / Q000209:etiology* / Q000276:immunology* / Q000473:pathology; D006801:Humans; D007156:Immunologic Memory; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007519:Isoantigens; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016176:T-Lymphocyte Subsets / Q000276:immunology*; D013602:T-Lymphocytes, Cytotoxic / Q000276:immunology; D016559:Tacrolimus / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D007519:Isoantigens; D023201:CD40 Ligand; D016559:Tacrolimus