¿Son los recuentos de células T reguladoras en sangre periférica un biomarcador predictivo y pronóstico para mejorar los resultados en el trasplante renal?una revisión sistemática
- Francisco Herrera Gómez 1
- Mónica Vásquez Seoane 2
- Waldo del Águila 3
- Débora Martín García 4
- Álvaro Maurtua-Briseño Meiggs 5
- Anunciación González López 6
- Beatriz Andrés Martín 6
- Álvaro Nava Rebollo 6
- Fernando Casquero Fernández 6
- Pilar Pascual Núñez 7
- Jesús Grande Villoria 6
- Jesús Bustamante Bustamante 8
- Carlos Ochoa Sangrador 9
- Claude Lambert 10
- Alicia Mendiluce Herrero 11
- 1 Departamento de Biología Celular, Histología y Farmacología, Facultad de Medicina, Universidad de Valladolid
- 2 Servicio de Gastroenterología, Hospital Santos Reyes, Complejo Asistencial de Burgos-Sacyl
- 3 Innere Medizin, Kliniken Erlabrunn gGmbH
- 4 Servicio de Nefrología, Unidad de Hipertensión e Investigación en Riesgo Cardiovascular, Hospital Clínico Universitario-Sacyl
- 5 Servicio de Urgencias, Hospital Universitario Río Hortega-Sacyl
- 6 Servicio de Nefrología, Hospital Virgen de la Concha, Complejo Asistencial de Zamora-Sacyl
- 7 Servicio de Nefrología, Unidad de Trasplante Renal, Hospital Clínico Universitario-Sacyl
- 8 Facultad de Medicina, Departamento de Medicina, Dermatología y Toxicología, Universidad de Valladolid
- 9 Unidad de Apoyo a la Investigación Hospital Virgen de la Concha, Complejo Asistencial de Zamora-Sacyl
- 10 Immunology Laboratory, University Hospital of Saint-Etienne
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11
Hospital Universitario de Valladolid
info
ISSN: 1886-2845
Año de publicación: 2017
Volumen: 38
Número: 1
Páginas: 40-56
Tipo: Artículo
Otras publicaciones en: Diálisis y trasplante: publicación oficial de la Sociedad Española de Diálisis y Trasplante
Resumen
Background: Peripheral blood regulatory T cell numbers could become a suitable biomarker for kidney transplant recipients. Objective: To evaluate the effect of mammalian Target Of Rapamycin (mTOR) inhibitors on regulatory T cell numbers, and the clinical interest of this effect. Design: Systematic review of published and unpublished studies. Data sources: Published and unpublished works databases. Review methods: Search of randomized controlled trials and cohort studies comparing regulatory T cell counts and acute rejection episodes between patients with and without mTOR inhibitors. Correlation between regulatory T cells and glomerular filtration rate might be supplied. Quality of all evidence retrieved was also evaluated. Results: 5 trials and 9 studies were included. Clinical differences made it difficult to obtain quantitative estimates of the effect of immunosuppression on regulatory T cell numbers. Nevertheless, qualitative analysis showed that there are higher regulatory T cell numbers under mTOR inhibitors treatment. Incidence of rejection was similar under calcineurin inhibitors and mTOR inhibitors despite different regultatory T cell numbers. Pooled correlation between regulatory T cells and glomerular filtration rate was, prospectively of 0.114 with 95% confidence interval –0.062-0.406, and retrospectively of 0.13 with 95% confidence interval 0.0-0.361. Evidence on regulatory T cells can relate to equal efficacy of calcineurin inhibitors and mTOR inhibitors in preventing acute rejection. Conclusions: Regulatory T cells counts may be associated with better outcomes under treatment with mTOR inhibitors. There is little relationship between regulatory T cells and glomerular filtration. Registration: PROSPERO (CRD42016046285).