Samenstelling van lymfklieren en het risico op afstoting na niertransplantatie.

The composition and function of lymphocyte subsets in the peripheral blood poorly correlate with clinical outcomes like biopsy-proven acute rejection (BPAR). Lymph nodes differ in lymphocyte composition and contain for example more follicular T-helper cells and less cytotoxic CD4+ T cells than peripheral blood.

It is known that the migration of antigen presenting cells from the allograft to the draining lymph nodes is essential for the initiation of the alloreactive T-cell response and subsequent rejection. Therefore, the lymph nodes may be a better site than the peripheral blood compartment to study cells involved in allograft rejection.

We would like to investigate whether the phenotypical features and functions of lymph node derived lymphocytes are associated with BPAR. To this aim a locoregional lymph node will be harvested during kidney transplantation and compared to the peripheral blood sample before surgery. Differences in lymph node derived versus peripheral blood derived lymphocytes have not been studied so far in patients with renal failure before the start of immunosuppressive medication.

To study lymphocellular composition and risk of BPAR, a patient cohort with a relative high risk of BPAR is warranted: patients with PRA >6% and/or >3 HLA mismatches on A, B and DR will be included.

In this study we will focus on ageing of the immune system and on T-follicular helper cells.

In a substudy the composition of lymph nodes after alemtuzumab induction therapy administered three weeks before ABO-incompatible kidney transplantation and its effect on BPAR will be studied.

The phenotypical and functional capacities of lymph node derived lymphocytes correlate better with biopsy-proven acute rejection after kidney transplantation than peripheral blood derived cells.

t=0 kidney transplantation

t=3 months, window for BPAR

harvesting of locoregional lymph node during kidney transplantation.