FOXP3 full length splice variant is associated with kidney allograft tolerance

Qais Waleed Saleh, Afsaneh Mohammadnejad, Martin Tepel*

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

9 Downloads (Pure)


Background: Progressive decline of allograft function leads to premature graft loss. Forkhead box P3 (FOXP3), a characteristic gene of T-regulatory cells, is known to be essential for auto-antigen tolerance. We assessed the hypothesis that low FOXP3 mRNA splice variant levels in peripheral blood cells early after transplantation are associated with progressive allograft injury.

Methods: Blood samples were prospectively collected from 333 incident kidney transplant recipients on the first and 29th postoperative day. We used quantitative polymerase chain reaction to determine transcripts of 3 isotypes of FOXP3 splice variants, including pre-mature FOXP3 and full length FOXP3 (FOXP3fl). We investigated the association between FOXP3 splice variant levels and the declines in estimated glomerular filtration rate (eGFR) of more than 5ml/min/1.73m2 within the first-year post-transplant using logistic regression.

Results: We observed lower FOXP3fl levels in recipients with declining eGFR (N = 132) than in recipients with stable eGFR (N = 201), (logarithmic value -4.13 [IQR -4.50 to -3.84] vs -4.00 [4.32 to -3.74], p=0.02). In ad hoc analysis pre-transplant FOXP3fl levels were similar in both groups. The association between FOXP3fl and declining eGFR was confirmed by multivariable analysis adjusted for potential confounding factors (Odds Ratio 0.51, 95% confidence interval 0.28 to 0.91: p=0.02). When stratifying FOXP3fl levels into quartiles, recipients with lower day1 FOXP3fl had the highest rate of declining eGFR (p=0.04).

Conclusion: Low FOXP3fl splice variant levels at the first postoperative day in kidney transplant recipients were associated with severe decline of eGFR, a well-known surrogate for hard endpoints.
Original languageEnglish
Article number1389105
JournalFrontiers in Immunology
Number of pages15
Publication statusPublished - 10. Apr 2024

Bibliographical note

Copyright © 2024 Saleh, Mohammadnejad and Tepel


  • kidney transplantation
  • forkhead box P3
  • splice isoforms
  • immunosuppression
  • biomarker
  • glomerular filtration


Dive into the research topics of 'FOXP3 full length splice variant is associated with kidney allograft tolerance'. Together they form a unique fingerprint.

Cite this