Pre‐transplant end‐stage renal disease‐related immune risk profile in kidney transplant recipients predicts post‐transplant infections

• DOI: 10.1111/tid.12534
• Publication Date: 2016-03-30T23:49:36Z
• Authors: T. Crepin; E. Gaiffe; C. Courivaud; C. Roubiou; C. Laheurte; B. Moulin; L. Frimat; P. Rieu; C. Mousson; A. Durrbach; A.‐E. Heng; P. Saas; J. Bamoulid; D. Ducloux
• Keywords: Adult; Graft Rejection; Male; 0301 basic medicine; T-Lymphocytes; Cytomegalovirus; Middle Aged; Opportunistic Infections; Kidney; Kidney Transplantation; Transplant Recipients; 3. Good health; 03 medical and health sciences; Postoperative Complications; Risk Factors; Cytomegalovirus Infections; Humans; Kidney Failure, Chronic; Female; Aged

AbstractBackgroundEnd‐stage renal disease (ESRD) is associated with premature aging of the T‐cell system. Nevertheless, the clinical significance of pre‐transplant ESRD‐related immune senescence is unknown.MethodsWe studied whether immune risk phenotype (IRP), a typical feature of immune senescence, may affect post‐transplant infectious complications. A total of 486 patients were prospectively studied during the first year post transplant. IRP was defined as positive cytomegalovirus serology with at least 1 of the following criteria: CD4/CD8 ratio <1 and/or CD8 T‐cell count >90th percentile.ResultsWe found that 47 patients (9.7%) had pre‐transplant IRP. IRP+ patients did not differ from IRP− patients for any clinical characteristics, but exhibited more pronounced immune senescence. Both opportunistic infections (43% vs. 6%, P < 0.001) and severe bacterial infection (SBI) (40% vs. 25%, P = 0.028) were more frequent in IRP+ patients. In multivariate analysis, IRP was predictive of both opportunistic infection (hazard ratio [HR] 2.97 [95% confidence interval {CI} 1.53–5.76], P = 0.001), and SBI (HR 2.33 [95% CI 1.34–3.92], P = 0.008). Acute rejection rates were numerically much lower in IRP+ patients. A total of 418 patients (86%) had biological evaluation 1 year post transplant. Among 41 IRP+ patients, 35 (85%) remained IRP+ 1 year post transplant.ConclusionPre‐transplant IRP is associated with an increased risk of post‐transplant infection.