Increase in CD8+CD158a+ T Cells in Kidney Graft Blood is Associated with Better Renal Function.

BACKGROUND Studies of liver and heart transplant patients have shown a gradual reconstruction of the CD8 KIR2D+ T cell subpopulations, measured in peripheral blood (PB), associated with better graft acceptance. The kinetics of these populations in kidney transplants, however, is still poorly understood, especially given the lack of studies of blood samples from the kidney graft. MATERIAL AND METHODS Flow cytometry was used to measure CD8+CD158a/b/e T cells in 69 kidney transplant patients who had stable renal function during follow-up. Measurements were made at 3, 6, and 12 months post-transplantation in graft capillary blood extracted by fine needle aspiration puncture (FNAP) and in PB. RESULTS No progressive increase was found in the PB subpopulations. However, the CD8+CD158a+ subsets increased significantly at 12 months in the graft blood versus the PB samples (3.91±4.59 vs. 2.84±4.71; p=0.021). The ratio of the percentage of CD8+CD158a+ cells in graft blood compared to PB at 12 months was associated with better renal function in those patients with a ratio ≥3 (66.6±14.53 vs. 55.7±21.6; p=0.032). CONCLUSIONS An increased ratio of CD8+CD158a+ cells, measured by flow cytometry, between graft blood and PB was associated with improved renal function.

Predictors of response and relapse in patients with idiopathic membranous nephropathy treated with tacrolimus.

BACKGROUND: Although tacrolimus is recommended by KDIGO Clinical Practice Guideline for Glomerulonephritis for the treatment of idiopathic membranous nephropathy (MN), little is known about factors that influence response and relapse of the disease after tacrolimus therapy. METHODS: Multicentre study that collected 122 MN patients with nephrotic syndrome and stable renal function treated with tacrolimus. Duration of treatment was 17.6 ± 7.2 months, including a full-dose and a tapering period. RESULTS: The percentage of remission was 60, 78 and 84% after 6, 12 and 18 months of treatment, respectively. The amount of proteinuria at baseline significantly predicted remission, the lower the baseline proteinuria the higher the probability of remission. Only 10 patients (8%) received concomitantly corticosteroids, and their rate of remission was similar (80% at 18 months). Among responders, 42% achieved complete remission (CR) and 58% partial remission (PR). Almost half (44%) of the responder patients relapsed. The amount of proteinuria at the onset of tacrolimus tapering was significantly higher in relapsing patients. By multivariable analysis, the presence of a PR versus CR at the onset of tacrolimus tapering and a shorter duration of the tapering period significantly predicted relapses. Tolerance was good and the number of adverse events low. CONCLUSIONS: Tacrolimus monotherapy is an effective and safe option for the treatment of MN with stable renal function. Relapses are frequent in patients with PR and can be partially prevented by a longer tapering period.