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Measuring donor-specific cytotoxic T cells helps identify patients who can reduce immunosuppressive medication.

Measurement of donor-specific cytotoxic T lymphocytes can identify patients in whom immunosuppressive medications can be safely reduced, according to a report in the July 15 issue of Transplantation.

Nicole van Besouw and colleagues from the University Hospital Rotterdam-Dijkzigt in Rotterdam, the Netherlands, prospectively studied 24 stable kidney transplant recipients who were switched at 12 months posttransplant from maintenance immunosuppressive therapy with cyclosporine to either azathioprine or mycophenolate mofetil. Eight months after the change, the maintenance drugs gradually were tapered to 50% of the starting dose. T-cell reactivity of the patients' peripheral blood mononuclear cells against donor spleen cells were tested immediately before the medication change. After the switch, the researchers attempted to correlate T-cell reactivity with the development of acute rejection.

Patients with and without rejection had "significant differences" in the numbers of donor-specific cytotoxic T-lymphocyte precursors before the drug conversion, the authors said. Acute rejection developed only in those with detectable levels of donor-specific cytotoxic T lymphocyte precursors before conversion. When no such precursor cells were detectable, rejection did not occur.

"A low number of donor-specific cytotoxic T lymphocytes identifies patients in whom the immunosuppressive load can be safely reduced," the investigators concluded. "To our knowledge, the present results are the first evidence that measuring...donor-specific T-cell reactivity is a suitable tool to predict acute rejection after conversion in immunosuppressive therapy."
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Comment:Measuring donor-specific cytotoxic T cells helps identify patients who can reduce immunosuppressive medication.
Publication:Transplant News
Article Type:Brief Article
Geographic Code:4EUNE
Date:Aug 28, 2000
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