期刊
KIDNEY INTERNATIONAL
卷 102, 期 6, 页码 1392-1408出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.kint.2022.08.025
关键词
calcineurin inhibitors; Epstein-Barr virus; immunosuppression; lymphoblastoid cell lines; mycophenolic acid; post-transplant lymphoproliferative disorder; rapamycin; T cells; transplantation
资金
- Bundesministerium fur Bildung und Forschung [ZIM, KK5029902AJ0]
- Bundesministerium fur Wirtschaft [St-2018-0014]
- Stiftung Mercator
- [13GW0338B]
Post-transplant lymphoproliferative disorder is a severe complication of immunosuppression following transplantation. This study investigated the impact of different immunosuppressants on EBV-antigen-specific T cells and lymphoblastoid cell lines. The results showed that rapamycin and mycophenolic acid inhibited lymphoblastoid cell-line proliferation, prednisolone and rapamycin-treated T cells exhibited normal cytokine production, and tacrolimus and cyclosporin A suppressed T-cell function.
Post-transplant lymphoproliferative disorder is a lifethreatening complication of immunosuppression following transplantation mediated by failure of T cells to control Epstein-Barr virus (EBV)-infected and transformed B cells. Typically, a modification or reduction of immunosuppression is recommended, but insufficiently defined thus far. In order to help delineate this, we characterized EBV-antigen-specific T cells and lymphoblastoid cell lines from healthy donors and in patients with a kidney transplant in the absence or presence of the standard immunosuppressants tacrolimus, cyclosporin A, prednisolone, rapamycin, and mycophenolic acid. Phenotypes of lymphoblastoid cell-lines and T cells, T cell-receptor-repertoire diversity, and T-cell reactivity upon co-culture with autologous lymphoblastoid cell lines were analyzed. Rapamycin and mycophenolic acid inhibited lymphoblastoid cell-line proliferation. T cells treated with prednisolone and rapamycin showed nearly normal cytokine production. Proliferation and the viability of T cells were decreased by mycophenolic acid, while tacrolimus and cyclosporin A were strong suppressors of T-cell function including their killing activity. Overall, our study provides a basis for the clinical decision for the modification and reduction of immunosuppression and adds information to the complex balance of maintaining anti-viral immunity while preventing acute rejection. Thus, an immunosuppressive regime based on mTOR inhibition and reduced or withdrawn calcineurin inhibitors could be a promising strategy for patients with increased risk of or manifested EBV-associated post-transplant lymphoproliferative disorder.
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