Background. Lymphocyte-depleting therapy is associated with long-lasting effects on repopulated T cells and subsequent increased rates of infections and malignancies. The mechanisms of T-cell repopulation and their posttransplantation kinetics are not fully understood. Methods. We studied thymopoiesis by CD31+ naïve T cells (recent thymic emigrants) and homeostatic proliferation by Ki-67+ T cells in rabbit antithymocyte globulin (rATG)Ytreated patients the first 6 months after transplantation. Patients receiving basiliximab or no induction therapy served as controls. Results. At 6 months after transplantation, T-cell numbers were lower than before transplantation in rATG-treated patients, whereas T-cell numbers remained stable in both control groups. In this time period, thymopoiesis was similar between the three treatment groups; CD8+ T cells showed the highest percentage of recent thymic emigrants. At month 1, percentages of Ki-67+ naBve and memory CD4+ and CD8+ T cells were the highest in rATG-treated patients, but these percentages declined in the months thereafter. When CD31 was used to distinguish between cytokine- and antigen-driven proliferation in naïve T cells, we found evidence for cytokine-dependent proliferation. Cytokine-dependent proliferation was also shown by in vivo increased percentages of phosphorylated STAT5 and high expression levels of the interleukin-7 receptor-α and interleukin-15 receptor-α by T cells. Conclusion. These findings demonstrate that, in the first month after rATG therapy, cytokine-induced homeostatic proliferation is involved in T-cell repopulation of both naBve and memory T cells. At later time points, the contribution of homeostatic proliferation diminished, which explains the observed incomplete T-cell recovery.

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Keywords Cytokines, Homeostatic proliferation, Kidney transplantation, T-cell depletion, Thymoglobulin, Thymopoiesis
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Journal Transplantation
Bouvy, A.P, Kho, M.M.L, Klepper, M, Litjens, N.H.R, Betjes, M.G.H, Weimar, W, & Baan, C.C. (2013). Kinetics of homeostatic proliferation and thymopoiesis after ratg induction therapy in kidney transplant patients. Transplantation, 96(10), 904–913. doi:10.1097/TP.0b013e3182a203e4