Correlaciones clínicas de los recuentos en sangre periférica de células T reguladoras en el post-trasplante renal
2017
espanolAntecedentes: Los recuentos de celulas T reguladoras en sangre periferica podrian utilizarse para la toma de decisiones en el manejo de los trasplantados renales. Objetivo: Evaluar la relaciones entre las celulas reguladoras y diversos resultados clinicos del post-trasplante renal. Metodos: Se determino el porcentaje de celulas reguladoras (CD4+CD25+CD127–) en 35 trasplantados estables tratados con anticalcineurinicos o inhibidores de la mammalian Target Of Rapamycin, y 11 trasplantados que presentaron cancer o infecciones severas siguiendo tratamiento con sirolimus o everolimus. Estos porcentajes se interpretaron de acuerdo a las circunstancias clinicas asociadas a un mayor riesgo de presentar rechazo agudo, cancer o infecciones severas en el post-trasplante, obtenidas por metodo Delphi. Resultados: Se observaron elevados porcentajes de celulas reguladoras en los trasplantados estables tratados con sirolimus o everolimus, y en los pacientes con cancer o infecciones severas. Estos elevados porcentajes no se asociaron a menos rechazo. El Delphi sugiere que las celulas reguladoras pueden ser insuficientes en los contextos de mayor inflamacion y con el uso de inmunosupresores nefrotoxicos, pudiendo asi contribuir a un mayor riesgo de presentar rechazo. Estas celulas pueden tambien asociarse a un mayor riesgo de cancer o infecciones severas en el post-trasplante en los casos, respectivamente, de un cancer previo para presentar un nuevo tumor, y de infecciones de repeticion o tratamiento con sirolimus o everolimus para presentar infecciones severas. Conclusion: Los recuentos de celulas T reguladoras deben interpretarse considerando el impacto de factores pro-inflamatorios y farmacos inmunosupresores. Respecto al cancer, probablemente deban considerarse otros factores. Hay una relacion entre las celulas reguladoras y las infecciones post-trasplante. EnglishBackground: Peripheral blood regulatory T cell counts might be used for decision-making in the clinical management of kidney transplant recipients. Objectives: Evaluation of the relationships between regulatory T cells and various clinical kidney transplant outcomes. Methods: The percentage of regulatory T cells (CD4+CD25+CD127–) was determined in 35 stable kidney transplant patients treated with calcineurin inhibitors or mammalian Target Of Rapamycin inhibitors, and 11 kidney recipients developing cancer or severe infections under treatment with sirolimus or everolimus. These percentages were interpreted according to clinical circumstances associated with an increased risk of acute rejection, cancer and severe infections in the post-transplant period, that were assessed by the Delphi method. Results: High regulatory T cell percentages were observed in stable patients under sirolimus or everolimus, and in patients with cancer and severe infections. These high percentages were not associated with rejection. The Delphi showed that these cells may be insufficient in the setting of an overwhelming inflammatory process and using nephrotoxic immunosuppressants, so that this may contribute to an increased risk of rejection. These cells may also be associated with an in- creased risk of cancer or severe infections in the post-transplant period in the cases of, respecti- vely, a past cancer for a new tumor, and recurrent infections and treatment with sirolimus or everolimus for severe infections. Conclusions: Regulatory T cell counts should be interpreted considering the impact of pro-inflam- matory factors and immunosuppressants. Regarding cancer, probably other factors should be considered. There is a relationship between regulatory T cells and post-transplant infections.
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