Tacrolimus-resistant regulatory T cells: Combining the best of both worlds?

The advancement of adoptive cell therapy has changed perspectives in solid organ transplantation. Immunosuppressive maintenance therapy in transplantation efficiently prevents allograft rejection, but is the main driver of cardio-metabolic complications, death caused by infections, malignancies, and cardiovascular disease.1,2 Minimization strategies for immunosuppression however are not unlimited and not without risk.3 Early phase 1/2a studies indicate that adoptive transfer of autologous Tregs in de novo living donor kidney allograft recipients is safe and enables reduction of triple-drug immunosuppression to low-dose tacrolimus monotherapy in the majority of patients.