New Perspectives in Pediatric Liver Transplantation
Reduced thyme functionality in paediatric patients after liver transplantation
Florencia González1,2, Brenda Dinatale1,2, Araujo Itaua Leston3, Savino Wilson3, Ana Rosa Pérez1,2, Oscar Bottasso1,2, Alejandro A Costaguta4, Guillermo Costaguta5, Carolina Rumbo6, Gabriel Gondolesi6.
1Instituto de Inmunología Clínica y Experimental de Rosario, CONICET, Rosario, Argentina; 2Facultad de Ciencias Médicas, Universidad de Rosario, Rosario, Argentina; 3Laboratorio de Pesquisas sobre o Timo, FIOCRUZ, Rio de Janeiro, Brazil; 4Liver Transplantation Unit, Sanatorio de Niños de Rosario, Rosario, Argentina; 5Gastroenterology, Hepatology and Nutrition, CHU Sainte-Justine, Montreal, QC, Canada; 6Unidad de Hepatología y Trasplante Hepático, Hospital Universitario Fundación Favaloro, Ciudad Autónoma de Buenos Aires, Argentina
Background: Children´s thymic functional capacity may be profoundly disturbed by immunosuppressive therapies. Since there are no current global reliable strategies to evaluate thymic function after solid organ transplantation, we aimed to explore by non-invasive techniques, how the functionality of the thymus is affected in pediatric patients undergoing immunosuppressive therapies after liver transplantation.
Methods: Eight (8) pediatric patients undergoing liver transplantation were included in the study (mean ± SEM; 6,25±1.8 years). Immunosuppressive protocols included calcineurin inhibitors, meprednisone, and basiliximab with mycophenolate eventually added if needed. Blood samples were assessed for recent thymic emigrants (RTEs, detected as CD4+CD45RA+CD31+ by flow cytometry) and T-cell receptor excision circles quantification (signal-joint TRECs by qPCR), before and 1 month after transplantation. Thymus size was also established by ultrasonography.
Results: We found an inverse association between age and RTEs levels, but not TRECs, at any time point. Reduced thymus size was also recorded in all patients. RTE levels were significantly decreased in 4/5 patients (80%) after 1 month of the liver transplant, and TRECs levels were significantly decreased in 5/8 patients (62.5%) at the same time point.
Conclusions: Immunosuppressive treatment might affect thymus size and functionality. This may have an impact on the frequency of infections and graft tolerance.
Research Scholarship from the Latin American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (LASPGHAN).
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