Transplantation elicits a clonally diverse CD8⁺ T cell response that is comprised of potent CD43⁺ effectors

CD8⁺ T cells mediate acute rejection of allografts, which threatens the long-term survival of transplanted organs. Using MHC class I tetramers, we find that allogeneic CD8⁺ T cells are present at an elevated naive precursor frequency relative to other epitopes, only modestly increase in number after grafting, and maintain high T cell receptor diversity throughout the immune response. While antigen-specific effector CD8⁺ T cells poorly express the canonical effector marker KLRG-1, expression of the activated glycoform of CD43 defines potent effectors after transplantation. Activated CD43⁺ effector T cells maintain high expression of the coreceptor induced T cell costimulator (ICOS) in the presence of CTLA-4 immunoglobulin (Ig), and dual CTLA-4 Ig/anti-ICOS treatment prolongs graft survival. These data demonstrate that graft-specific CD8⁺ T cells have a distinct response profile relative to anti-pathogen CD8⁺ T cells and that CD43 and ICOS are critical surface receptors that define potent effector CD8⁺ T cell populations that form after transplantation.