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. 2024 May 16;216(3):307-317.
doi: 10.1093/cei/uxae011.

Albumin influences leucocyte FcRn expression in the early days of kidney transplantation

Pierre Boulard  1   2 , Nicolas Azzopardi  3 , Romain Levard  2 , Jean-Marie Cornec  2 , Juliette Lamamy  3 , Bérénice Prieur  2 , Marie-Véronique Demattei  3 , Hervé Watier  2   3 , Philippe Gatault  4   5 , Valérie Gouilleux-Gruart  2   3
Affiliations

Albumin influences leucocyte FcRn expression in the early days of kidney transplantation

Pierre Boulard et al. Clin Exp Immunol. .

Abstract

FcRn, a receptor originally known for its involvement in IgG and albumin transcytosis and recycling, is also important in the establishment of the innate and adaptive immune response. Dysregulation of the immune response has been associated with variations in FcRn expression, as observed in cancer. Recently, a link between autophagy and FcRn expression has been demonstrated. Knowing that autophagy is strongly involved in the development of reperfusion injury in kidney transplantation and that albuminemia is transiently decreased in the first 2 weeks after transplantation, we investigated variations in FcRn expression after kidney transplantation. We monitored FcRn levels by flow cytometry in leukocytes from 25 renal transplant patients and considered parameters such as albumin concentrations, estimated glomerular filtration rate, serum creatinine, serum IgG levels, and ischaemia/reperfusion time. Two groups of patients could be distinguished according to their increased or non-increased FcRn expression levels between days 2 and 6 (d2-d6) post-transplantation. Leukocyte FcRn expression at d2-d6 was correlated with albumin concentrations at d0-d2. These results suggest that albumin concentrations at d0-d2 influence FcRn expression at d2-d6, raising new questions about the mechanisms underlying these original observations.

Keywords: FcRn; albumin; flow cytometry; kidney transplantation.

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Conflict of interest statement

None declared.

Figures

Graphical Abstract
Graphical Abstract
Figure 1.
Figure 1.
Analysis of FcRn expression in leukocyte populations by flow cytometry. (A) Gating strategy. a: Gating on singlets from FSC/SSC gate. b: Leukocyte gating based on structure (SSC) and CD45 expression. c: Anti-FcRn antibody staining in total leukocyte population. (B) Representative fluorescence intensity of anti-FcRn antibody (dark grey) and isotype control (light grey) for a healthy donor.
Figure 2.
Figure 2.
Monitoring of leukocyte FcRn expression in renal transplant patients. Data are expressed as MFI ratio between FcRn staining and isotype control. Each line represents one patient. Horizontal dotted line and grey area represent mean and range of normal FcRn values (1.43–2.71) obtained from 20 healthy donors. FcRn expression in the ‘increased FcRn expression’ group of patients (in red, n = 9, A) and ‘non-increased FcRn expression’ (in blue, n = 16, B) during the follow-up of the study. (C) Monitoring of FcRn expression in the ‘non-increased FcRn expression’ (blue) or ‘increased FcRn expression’ (red) group of patients at d-1, d0–d2, d2–d6, >d6. Results are presented as mean ± SD. P-values were calculated with repeated measures ANOVA between groups or with Tukey’s HSD test within each group.
Figure 3.
Figure 3.
Albumin concentrations in the ‘increased FcRn expression’ (red) and the ‘non-increased FcRn expression’ (blue) groups of patients. (A) Before or after kidney transplantation and (B) detailed at d0–d2, d2–d6, >d6 in the serum of 25 patients (mean ± SD). The horizontal grey zone represents the range of normal albumin values [35–45 g/L]. P-values (0.0032 and 0.025) were calculated with a Mann–Whitney test.
Figure 4.
Figure 4.
Correlation between FcRn expression at d2–d6 and albumin concentrations at d0–d2 in the whole cohort (n = 25).
Figure 5.
Figure 5.
IgG serum levels at d-1 (pre-transplant) and M1 (1 month post-transplant) (A) in the whole cohort, (B) in the ‘non-increased FcRn expression’ (blue), and (C) in the ‘increased FcRn expression’ (red) groups of patients. P-values (<0.0001 and 0.0036) were calculated with paired t-test.
Figure 6.
Figure 6.
Analysis of serum creatinine and eGFR rate in ‘increased FcRn expression’ (red) and ‘non-increased FcRn expression’ (blue) groups of patients after kidney transplantation. (A) Serum creatinine concentrations on day 1 (d1), d2, d3, d4, d5, d6, and d7. We assigned a serum creatinine value of 500 µmol/L to the dialysis patient during the first week. (B) Estimated glomerular filtration rate at 1 month (M1), 2 months (M2), and 3 months (M3) after kidney transplantation. Results are presented as mean ± SD.
Figure 7.
Figure 7.
Analysis of ischaemia time in ‘increased FcRn expression’ (red) and ‘non-increased FcRn expression’ (blue) groups of patients after kidney transplantation. (A) Cold ischaemia time. (B) Warm ischaemia time. (C) FcRn expression in living and non-living donors after kidney transplantation at d-1, d0–d2, d2–d6, and >d6. (D) FcRn expression in the post-transplant period according to immunosuppressive regimens (basiliximab or anti-thymocyte globulin treatment). Results are presented as mean ± SD.
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