title: Elevation of CD4+ differentiated memory T cells is associated with acute cellular and antibody-mediated rejection after liver transplantation.
abstract: BACKGROUND
  It is now well known that the outcome after allogeneic transplantation, such as incidence of acute rejections, very much depends on the individual's immune reactivity status. There is also increasing evidence that the presence of preexisting memory T cells can affect antigraft immune responses.
  
  
  METHODS
  In a prospective study, we monitored peripheral CD4 and CD8 central memory, effector memory, and terminal differentiated effector memory (TEMRA) T cells in 55 patients who underwent deceased liver transplantation and received conventional immunosuppressive treatment with or without basiliximab induction. The primary endpoint of the study was acute allograft rejection during a 1-year follow-up period.
  
  
  RESULTS
  We observed significantly increased proportions of CD4 and CD8 TEMRA cells in patients before transplantation compared with healthy controls (P=0.006 and 0.009, respectively). This characteristic was independent of the underlying disease. In patients with no signs of acute rejection, we observed an immediate reduction of CD4 TEMRA cells. In contrast, patients who experienced acute cellular rejection, and especially antibody-mediated rejection, displayed persistent elevated TEMRA cells (P=0.017 and 0.027, respectively). Basiliximab induction therapy did not influence CD4 and CD8 TEMRA numbers.
  
  
  CONCLUSIONS
  Conventional immunosuppressive or basiliximab treatment cannot control the persistence of TEMRA T cells, which may contribute to acute cellular rejection and antibody-mediated rejection after liver transplantation. In the future, specific targeting of TEMRA cells in selected patients may prevent the occurrence of difficult to treat steroid-resistant rejections, thereby leading to improved patient outcome.
authors.affiliation: Department of Visceral- and Transplant Surgery, Charite Universitätsmedizin, Augustenburger Platz 1, Berlin, Germany.
authors.forename: Undine A
authors.initials: UA
authors.lastname: Gerlach
authors.forename: Katrin
authors.initials: K
authors.lastname: Vogt
authors.forename: Stephan
authors.initials: S
authors.lastname: Schlickeiser
authors.forename: Christian
authors.initials: C
authors.lastname: Meisel
authors.forename: Mathias
authors.initials: M
authors.lastname: Streitz
authors.forename: Desiree
authors.initials: D
authors.lastname: Kunkel
authors.forename: Christine
authors.initials: C
authors.lastname: Appelt
authors.forename: Stefanie
authors.initials: S
authors.lastname: Ahrlich
authors.forename: Nils
authors.initials: N
authors.lastname: Lachmann
authors.forename: Peter
authors.initials: P
authors.lastname: Neuhaus
authors.forename: Andreas
authors.initials: A
authors.lastname: Pascher
authors.forename: Birgit
authors.initials: B
authors.lastname: Sawitzki
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000077552:Basiliximab; D015496:CD4-Positive T-Lymphocytes / Q000166:cytology*; D018414:CD8-Positive T-Lymphocytes / Q000166:cytology; D002454:Cell Differentiation; D005260:Female; D006084:Graft Rejection / Q000276:immunology*; D006801:Humans; D007156:Immunologic Memory / Q000276:immunology*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017093:Liver Failure / Q000276:immunology / Q000628:therapy*; D016031:Liver Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D020133:Reverse Transcriptase Polymerase Chain Reaction
chemical_list: D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab