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Diabetic kidney transplant recipients: Impaired infection control and increased alloreactivity
Author(s) -
Schachtner Thomas,
Stein Maik,
Reinke Petra
Publication year - 2017
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12986
Subject(s) - medicine , immunosuppression , diabetes mellitus , transplantation , elispot , tacrolimus , immunology , kidney transplantation , gastroenterology , immune system , t cell , endocrinology
Background Post‐transplantation diabetes mellitus ( PTDM ) has been associated with inferior patient and allograft outcomes. However, previous studies did not identify differences in infection control and alloreactivity. Methods We studied 449 kidney transplant recipients ( KTR s) between 2005 and 2013. Fifty (11.1%) KTR s were diagnosed with PTDM and 60 (13.4%) KTR s with pre‐existing diabetes. Samples were collected pretransplantation, at +1, +2, +3 months post‐transplantation. CMV specific and alloreactive T cells were quantified by interferon‐γ Elispot assay. Lymphocyte subpopulations were quantified by flow cytometry. Results Upon multivariate analysis, age, obesity, and the use of tacrolimus increased the risk of PTDM ( P <.05). KTR s with pre‐existing diabetes/ PTDM showed higher rates of sepsis ( P <.01). Total CD 3+ and CD 4+ T cell counts were significantly lower in KTR s with PTDM /pre‐existing diabetes post‐transplantation ( P <.05). No differences were observed for CMV ‐specific T cells between any group ( P >.05). KTR s developing PTDM showed increased frequencies of alloreactive T‐cells post‐transplantation ( P <.05). Conclusions Our results suggest higher rates of infection in KTR s with pre‐existing diabetes/ PTDM that may be attributed to impaired overall immunity. Higher frequencies of alloreactive T cells contribute to inferior long‐term outcomes. As acute rejection, but not pre‐existing diabetes/ PTDM , was associated with inferior allograft survival and function, maintaining adequate immunosuppression to prevent rejection seems important.