Peripheral natural killer cell and allo-stimulated T-cell function in kidney transplant recipients associate with cancer risk and immunosuppression-related complications.
Reducing immunosuppression has been proposed as a means of preventing cancer in kidney transplant recipients but this can precipitate graft rejection. Here we tested whether anti-tumor natural killer (NK) cell and allo-responsive T-cell function in kidney transplant recipients may predict cancer risk and define risk of rejection. NK cell function was measured by the release of lactate dehydrogenase and T-cell allo-response by interferon-γ quantification using a panel of reactive T-cell enzyme-linked immunospot (ELISPOT) in 56 kidney transplant recipients with current or past cancer and 26 kidney transplant recipients without cancer. NK function was significantly impaired and the allo-response was significantly lower in kidney transplant recipients with cancer. With prospective follow-up, kidney transplant recipients with poor NK cell function had a hazard ratio of 2.1 (95% confidence interval 0.97-5.00) for the combined end point of metastatic cancer, cancer-related death, or septic death. Kidney transplant recipients with low interferon-γ release were also more likely to reach this combined end point. Thus, posttransplant monitoring of allo-immunity and NK cell function is useful for assessing the risk of over immunosuppression for the development of malignancy and/or death from cancer or sepsis.
Centre for Clinical and Experimental Transplantation (CCET), Central Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, SA, Australia.|Department of Medicine, University of Adelaide, Adelaide, SA, Australia.
Christopher M
CM
Hope
Centre for Clinical and Experimental Transplantation (CCET), Central Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, SA, Australia.|Department of Medicine, University of Adelaide, Adelaide, SA, Australia.
Alexander
A
Troelnikov
Centre for Clinical and Experimental Transplantation (CCET), Central Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, SA, Australia.
William
W
Hanf
Centre for Clinical and Experimental Transplantation (CCET), Central Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, SA, Australia.|Department of Medicine, University of Adelaide, Adelaide, SA, Australia.
Shilpanjali
S
Jesudason
Centre for Clinical and Experimental Transplantation (CCET), Central Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, SA, Australia.|Department of Medicine, University of Adelaide, Adelaide, SA, Australia.
Patrick T
PT
Coates
Department of Medicine, Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Peter S
PS
Heeger
Centre for Clinical and Experimental Transplantation (CCET), Central Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, SA, Australia.|Department of Medicine, University of Adelaide, Adelaide, SA, Australia.
Robert P
RP
Carroll