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. 2009 Oct;54(10):2253-63.
doi: 10.1007/s10620-008-0618-y. Epub 2008 Dec 11.

Impact of preexisting circulating effector T cells on the outcome of ABO-incompatible adult LDLT

Hiroto Egawa  1 , Kazue Ozawa, Yasutsugu Takada, Satoshi Teramukai, Akira Mori, Mureo Kasahara, Kohei Ogawa, Yasuhiro Ogura, Fumitaka Oike, Toshimi Kaido, Masako Ono, Hiroshi Sato, Kenji Takai, Shinji Uemoto
Affiliations

Impact of preexisting circulating effector T cells on the outcome of ABO-incompatible adult LDLT

Hiroto Egawa et al. Dig Dis Sci. 2009 Oct.

Abstract

Our aim was to clarify the significance of phenotype of circulating CD8 T(+) cells on the outcome of ABO-incompatible (ABO-I) living donor liver transplantation (LDLT). Twenty-six recipients undergoing ABO-I LDLT and 92 undergoing ABO-compatible (ABO-C) LDLT were classified into three groups according to preoperative proportion of CD8 T(+) cells: naive-dominant (group I), effector memory-dominant (group II), and effector-dominant (group III) recipients. The clinical courses were analyzed. The results showed that in ABO-C groups I and II and in ABO-I group I, effector cells remained above the pretransplant levels after tacrolimus administration. However, in ABO-C group III and ABO-I groups II and III, effector cells were down-regulated for a prolonged period, along with markedly decreased perforin expression and frequent life-threatening complications. ABO-I group II and group III recipients had higher infection rates. It was concluded that recipients with preexisting high effector CD8 T(+) cells are unfavorable candidates for ABO-I LDLT.

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Figures

Fig. 1
Fig. 1
The scheme of immunosuppression regimen and the changes in trough levels of tacrolimus after LDLT in ABO-C and ABO-I recipients. a For a recipient of ABO-I LDLT, rituximab was administered once at a dose of 375 mg/m2 as prophylaxis before transplantation. PEX was performed, aiming for an antibody titer 8-fold less before transplantation. Local infusion therapy was continued for 3 weeks. Intravenous cyclophosphamide was administered for 2 weeks at a dose of 2 mg/kg/day and then MMF was administered (500 mg twice/day). MMF was continued for 1 year after transplantation. Basic immunosuppression consisting of tacrolimus and corticosteroids was the same for ABO-C LDLT. b There was no significant differences in trough levels of tacrolimus between ABO-C and ABO-I recipients. LDLT, living donor liver transplantation; HAI, hepatic artery infusion; PVI, portal vein infusion; PGE1, prostaglandin E1; PEX, plasmapheresis
Fig. 2
Fig. 2
Changes in the proportion (top) and the difference (bottom) of CD8+ effector T cells after LDLT in 3 groups of ABO-C and ABO-I recipients. % E difference refers to % difference of CD8+ effector T cells. LDLT, living donor liver transplantation
Fig. 3
Fig. 3
Changes in the % difference of perforin in CD8+ effector T cells after LDLT in three groups of ABO-C and ABO-I recipients. a The proportion of perforin expression is expressed as % of CD8+ T cells. b Flow cytometry of representative ABO-C and ABO-I group III recipients. Dot plots show double staining for perforin/CCR7. Perforin/CCR7 was gated on CD8+CD45RO−. Cells in the upper left are presented as %. Tac, tacrolimus; LDLT, living donor liver transplantation
Fig. 4
Fig. 4
The frequencies of infection, ACR, LTCs, and hospital mortality after ABO-C LDLT and ABO-I LDLT. White bars show ABO-C LDLT, dark bars ABO-I LDLT. ACR, acute cellular rejection; LTC, life-threatening complication; LDLT, living donor liver transplantation
See this image and copyright information in PMC

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