Clinical and immunological follow-up of very long-term kidney transplant recipients treated with calcineurin inhibitors indicates dual phenotypes

Operationally tolerant kidney transplant recipients harbor an immunological signature, associated with low rejection risk, and focused on B lymphocytes. Here, we investigated whether patients with long-term transplantation and still on immunosuppressive therapy would present such a signature of low immunological rejection risk, compared to more recently transplanted patients. Of 114 kidney transplant recipients enrolled, 38 with more than 25 years of graft survival and stable graft function under calcineurin inhibitors, were matched with two different groups of transplanted patients (10-15 and 5-7 years after transplantation). Three phenotypes associated with low immunological rejection risk (Tfh, B and regulatory T cells), initially found in operationally tolerant kidney transplant recipients, and the composite score of tolerance (combination of six transcriptomic markers, age at transplantation and age at sampling) were analyzed. We found that very long-term patients were characterized by a significantly lower percentage of total B cells, a significantly higher proportion of CD24(Hi)CD38(Lo) memory B cells, significantly fewer CD24(Lo)CD38(Lo) naive B cells, and a significantly lower proportion of PD1(Hi)CCR7(Lo) Tfh lymphocytes than more recently transplanted patients. This phenotype is associated with a positive composite score of tolerance in patients transplanted for more than 25 years. Thus, our study suggests a dual phenotype in very long-term kidney transplanted patients with an immunological profile associated with low rejection risk.

Automated summary

Patients with more than 25 years of graft survival after kidney transplantation exhibit an immunological signature associated with low rejection risk, characterized by lower total B cell percentage, higher proportion of CD24(Hi)CD38(Lo) memory B cells, fewer CD24(Lo)CD38(Lo) naive B cells, and lower proportion of PD1(Hi)CCR7(Lo) Tfh lymphocytes.