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Does borderline kidney allograft rejection always require treatment?

Background. - Borderline rejection (Bord-R) is a frequent diagnosis in renal transplantation, and there is increasing evidence that regulatory T lymphocytes are involved in its pathogenesis. Current histopathologic practice does not differentiate between graft-protecting and -damaging T lymphocytes,...

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Main Authors: Németh, Dorottya (Author) , Ovens, Jörg (Author) , Opelz, Gerhard (Author) , Sommerer, Claudia (Author) , Döhler, Bernd (Author) , Becker, Luis Eduardo (Author) , Groß-Weissmann, Marie-Luise (Author) , Waldherr, Rüdiger (Author) , Mieth, Markus (Author) , Sadeghi, Mahmoud (Author) , Schmidt, Jan (Author) , Langer, Robert M. (Author) , Zeier, Martin (Author) , Süsal, Caner (Author)
Format: Article (Journal)
Language:English
Published: 2010
In: Transplantation
Year: 2010, Volume: 90, Issue: 4, Pages: 1-6
ISSN:1534-6080
DOI:10.1097/TP.0b013e3181e81b16
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1097/TP.0b013e3181e81b16
Verlag, lizenzpflichtig, Volltext: https://journals.lww.com/transplantjournal/Fulltext/2010/08270/Does_Borderline_Kidney_Allograft_Rejection_Always.16.aspx
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Author Notes:Dorottya Németh, Jörg Ovens, Gerhard Opelz, Claudia Sommerer, Bernd Döhler, Luis E. Becker, Marie-Luise Gross, Rüdiger Waldherr, Markus Mieth, Mahmoud Sadeghi, Jan Schmidt, Robert M. Langer, Martin Zeier, and Caner Süsal

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520 |a Background. - Borderline rejection (Bord-R) is a frequent diagnosis in renal transplantation, and there is increasing evidence that regulatory T lymphocytes are involved in its pathogenesis. Current histopathologic practice does not differentiate between graft-protecting and -damaging T lymphocytes, and patients with Bord-R routinely receive rejection treatment. We analyzed Treg-associated forkhead box P3 (Foxp3) gene expression in Bord-R and more severe forms of acute rejection episodes (ARE). - Methods. - Foxp3 transcripts were measured in 520 serial peripheral blood samples from 177 kidney graft recipients obtained during the first 20 days posttransplantation. - Results. - The highest Foxp3 transcripts were observed in patients with Bord-R or without rejection and the lowest in patients with ARE. Patients with Bord-R on posttransplant days 5 to 7 showed an increased Foxp3 transcript level of 156%, which increased to 302% by posttransplant days 14 to 16. In contrast, patients with ARE demonstrated significantly lower Foxp3 gene expression than that observed in Bord-R, nonrejectors, or acute tubular necrosis patients (P=0.001, P<0.001, and P=0.005, respectively, on days 11-13). Acute tubular necrosis patients demonstrated intermediately high Foxp3 gene expression. - Conclusions. - Our data indicate that increased Treg activity in peripheral blood is a frequent feature of Bord-R. This finding questions the appropriateness of rejection treatment in all patients with the histopathologic diagnosis “Bord-R”. 
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