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Pre‐transplant end‐stage renal disease‐related immune risk profile in kidney transplant recipients predicts post‐transplant infections
Author(s) -
Crepin T.,
Gaiffe E.,
Courivaud C.,
Roubiou C.,
Laheurte C.,
Moulin B.,
Frimat L.,
Rieu P.,
Mousson C.,
Durrbach A.,
Heng A.E.,
Saas P.,
Bamoulid J.,
Ducloux D.
Publication year - 2016
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12534
Subject(s) - medicine , hazard ratio , end stage renal disease , immune system , renal transplant , transplantation , confidence interval , immunology , disease , gastroenterology
Abstract Background End‐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. Methods We 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: CD 4/ CD 8 ratio <1 and/or CD 8 T‐cell count >90th percentile. Results We 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. Conclusion Pre‐transplant IRP is associated with an increased risk of post‐transplant infection.