Developing a Rationale for an Appropriate Immunosuppressive Regimen in Lung vs Kidney Transplant Recipients

Abstract

Introduction Lung transplant is associated with a high rate of complications in comparison with kidney transplant, specifically related to surgical complications, infections and acute rejection as well as a lower overall graft survival. We studied the circulating cytokine profile following transplantation to better understand the factors driving the immune response to the allograft in order to know how to design a more rational therapeutic approach to transplantation. Materials and Methods We included in the study 17 lung and 10 kidney transplant patients. Serum samples were obtained pre-transplant and days 1, 2, 3, 4, 14 and 30 post-transplant. A cytokine profile including 26 cytokines was analyzed by Luminex. We compared the difference in cytokines between the kidney and lung transplant patients. Results The general characteristics of the total sample and of kidney and lung transplant are presented in Table 1. Basiliximab was used as induction therapy in all the lung transplant patients, Thymoglobuline being the induction therapy used most in kidney transplant patients. The rate of infections and the days of hospitalization were higher in the lung transplant group. Extubation the first day post-transplant was achieved in 9 of the lung transplant patients. There was only one episode of treated acute rejection in the kidney transplant group. With respect to the cytokine profile, baseline MIG and IP-10 were higher in the kidney transplant group, and IL-5 was higher in the lung transplant group (p <0.005). The peak of IL5, IL6 and IL15 the day 1 post-transplant was statistical significant higher in the group of lung transplants. In the kidney transplant group, MIG maintained higher levels (p <0.05) than in the lung transplant group until day 4 post-transplant. Figure 1 shows the change in the levels of these cytokines, and in Figure 2, the difference in the levels of IL6 at 1 day post-transplant that was statistically significantly higher in the group of lung transplant patients with extubation after 1 day post-transplant. Conclusions The change of the cytokine profile is different between kidney and lung transplant. Thymoglobulin as induction therapy may be responsible for the lower levels of most cytokines in the kidney transplant group. The fact that the level of IL-6 was higher in the lung transplant group with extubation after day 1 may indicate a benefit for the use of anti-IL6 as induction therapy in lung transplant patients.