title: Kidney transplant recipients after nonrenal solid organ transplantation show low alloreactivity but an increased risk of infection.
abstract: The number of kidney transplant recipients (KTRs) after nonrenal solid organ transplantation (SOT) has increased to almost 5%. Knowledge on patient and allograft outcomes, infections, and alloreactivity, however, remains scarce. We studied 40 KTRs after nonrenal SOT. Seven hundred and twenty primary KTRs and 119 repeat KTRs were used for comparison. Samples were collected pretransplantation, at +1, +2, and +3 months post-transplantation. Alloreactive and CMV-specific T cells were measured by interferon-γ ELISPOT assay. Patient survival in KTRs after SOT, primary and repeat KTRs was comparable. While death-censored allograft survival was comparable between KTRs after SOT and primary KTRs, KTRs after SOT showed superior 5-year death-censored allograft survival of 92.5% compared to 81.2% in repeat KTRs. Interestingly, KTRs after SOT show less preformed panel-reactive antibodies, frequencies of alloreactive T cells, and acute rejections compared to repeat KTRs. KTRs after SOT, however, show higher incidences of EBV viremia and PTLD, sepsis, and death from sepsis. Impaired CMV-specific cellular immunity was associated with more CMV replication compared to repeat KTRs. Our results suggest comparable patient and allograft outcomes in KTRs after SOT and primary KTRs. The observed low alloreactivity may contribute to excellent allograft outcomes. Caution should be taken in KTRs after SOT regarding infectious complications due to overimmunosuppression.
authors.affiliation: Department of Nephrology and Internal Intensive Care, Charité University Medicine Berlin, Campus Virchow Clinic, Berlin, Germany.|Berlin-Brandenburg Center of Regenerative Therapies (BCRT), Berlin, Germany.|Charité and Max-Delbrück Center, Berlin Institute of Health (BIH), Berlin, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schachtner
authors.affiliation: Berlin-Brandenburg Center of Regenerative Therapies (BCRT), Berlin, Germany.
authors.forename: Maik
authors.initials: M
authors.lastname: Stein
authors.affiliation: Department of Nephrology and Internal Intensive Care, Charité University Medicine Berlin, Campus Virchow Clinic, Berlin, Germany.|Berlin-Brandenburg Center of Regenerative Therapies (BCRT), Berlin, Germany.
authors.forename: Petra
authors.initials: P
authors.lastname: Reinke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000150:complications / Q000276:immunology*; D058501:Enzyme-Linked Immunospot Assay; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007371:Interferon-gamma / Q000378:metabolism; D007668:Kidney / Q000276:immunology; D016030:Kidney Transplantation / Q000009:adverse effects*; D007963:Leukocytes, Mononuclear / Q000166:cytology; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000150:complications / Q000276:immunology / Q000601:surgery*; D012189:Retrospective Studies; D013154:Spleen / Q000378:metabolism; D013997:Time Factors; D066027:Transplant Recipients; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D007371:Interferon-gamma
keywords: alloreactivity; infections; kidney transplantation; patient and allograft outcomes; solid organ transplantation