T Cell-mediated Rejection: Emerging Relationships — Puzzles and Paradoxes

12:10: Patterns of TCMR: Relationships to Immunosuppression Therapies

Allan D. Kirk, Emory University, Atlanta, USA

T cell-mediated rejection (TCMR) is a common disorder in solid organ transplantation. It is preventable in most cases given appropriate immune prophylaxis, and it is the balance between sufficient immune therapy to prevent TCMR and the consequences of excessive immune suppression that defines the field of transplantation. Importantly, TCMR is almost always reversible given prompt recognition and therapy, and almost always leads to serious graft impairment if it is ignored. This broad outcome range and the associated narrow therapeutic window for therapy require that the diagnostic criteria for TCMR be clear. Our definition of TCMR has developed in an era of calcineurin inhibitor-based triple immunosuppressive therapy and the histopathological features of TCMR have been defined in this therapeutic context. New regimens that depart radically from the existing therapeutic background are being explored with increasing frequency. These include depletional induction strategies and calcineurin inhibitor-free protocols using costimulation blockade. The features of TCMR appear to be influenced significantly by these alternative regimens, and the implications of this influence on diagnosis and treatment will be discussed in this presentation.