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Abstract: TH-OR78

The Alteration of Monocyte Subsets and the Early Acute Rejection After Kidney Transplantation

Session Information

Category: Transplantation

  • 2101 Transplantation: Basic


  • Song, Jeongin, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
  • Cho, Jeongmin, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
  • Kim, Yong Chul, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
  • Lee, Hajeong, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)

Despite the use of recent immunosuppressive agents that mainly modulate adaptive immunity, early acute rejection (EAR) remains an unresolved problem in kidney transplantation (KT). Innate immune cells including monocyte/macrophage-lineage cells may contribute to the EAR occurrence, so we explored the population and phenotypic changes of circulating monocytes in KT recipients.


Pre- and post-KT peripheral blood mononuclear cells (PBMCs) from 60 KT recipients and 20 live donor samples were collected and analyzed by flow cytometry. Monocytes were classified into three types: classical (CD14++CD16-), intermediate (CD14++CD16+), and non-classical (CD14+CD16++) monocytes. Post-KT samples were collected at the same time as the protocol biopsy within post-operative days 14. The outcome was biopsy-proven acute rejection (BPAR) events excluding borderline T-cell mediated rejection.


A total of 60 study population, BPAR was diagnosed in 10 of the KT recipients, and 7 of them received living donor KT. In recipients without EAR, the proportions of classical monocytes among CD45+ cells were significantly increased(Fig. 1A, 8.90±5.40% vs 14.60±7.97%, p<0.001) after KT, and the proportions of non-classical monocytes were distinctly decreased(Fig. 1C, 1.45±1.70% vs 0.40±0.47%, p<0.001) after KT. In contrast, in BPAR patients, there were no significant differences in the proportions of all monocyte subsets after KT. Interestingly, the proportion of non-classical monocytes was the lowest in BPAR patients than KT recipients without rejection or kidney donors in both the pre-and post-KT periods(Fig. 1F. 0.72±0.42% vs 1.45±1.67% and 1.09±0.56% at pre-KT (p=0.150 and 0.652), 0.72±0.42% vs 0.37±0.37% and 1.09±0.56% at post-KT (p=0.035 and 0.204)).


Our findings suggest that changes in monocyte subsets before and after KT are associated with EAR occurrence in KT recipients. Non-classical monocytes, in particular, may play an important role in the development of EAR.

Figure 1. Changes in each monocyte subset before and after KT. (No AR; No acute rejection, BPAR; biopsy-proven acute rejection)