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Multicenter Study
. 2020 Jul 31:11:1653.
doi: 10.3389/fimmu.2020.01653. eCollection 2020.

Pre-transplant Thymic Function Predicts Is Associated With Patient Death After Kidney Transplantation

Cécile Courivaud  1   2   3   4 , Jamal Bamoulid  1   2   3   4 , Thomas Crepin  1   2   3   4 , Emilie Gaiffe  4   5 , Caroline Laheurte  1   6 , Philippe Saas  1   2   3   5   6 , Didier Ducloux  1   2   3   4   5
Affiliations
Multicenter Study

Pre-transplant Thymic Function Predicts Is Associated With Patient Death After Kidney Transplantation

Cécile Courivaud et al. Front Immunol. .

Abstract

Accelerated thymic involution is a main feature of end-stage renal disease (ESRD)-associated immune senescence. Recent evidences suggest that ESRD-associated immune senescence is associated with adverse outcomes in dialysis patients. However, no study focused on the association between pre-transplant thymic function and patient survival after transplantation. We conducted a prospective, multicenter study to assess whether pre-transplant thymic function measured by recent thymic emigrants (RTE) may predict death after first kidney transplantation. Results were tested in a validation cohort. Nine hundred and sixty-seven incident kidney transplant recipients were included in the prospective study. Mean follow up was 5.1 + 2.9 years. Eighty two patients (8.5%) died during follow up. Lower RTE levels were associated with a higher risk of death (2.53; 95%CI, 1.54-4.39 for each decrease of 1 log in RTE; p < 0.001). Cancer-related death was particularly increased in patients with low RTE levels (4.23; 95%CI, 1.43-12.13; p = 0.007). One hundred and thirty-six patients having received a first kidney transplantation were included in the validation cohort. Lower TREC levels were associated with higher risk of death (1.90; 95%CI, 1.11-3.51 for each decrease of 1 log in RTE; p = 0.025). RTE were not associated with death-censored graft loss. Pre-transplant thymic function is strongly associated with death after transplantation. Attempt to reverse ESRD-related thymic loss may prevent premature death.

Keywords: cancer; death; immune senescence; kidney transplantation; thymus.

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Figures

Figure 1
Figure 1
Kaplan-Meier death in transplantation-free survival curves for patients according to quartiles o RTE. Ranges of RTE: Q1 [2–74], Q2 [75–135], Q3 [136–230], and Q4 [231–1,135].
Figure 2
Figure 2
(A) Kaplan-Meier cardiovascular death in transplantation-free survival curves for patients according to quartiles of RTE. (B) Kaplan-Meier infection-related death in transplantation-free survival curves for patients according to quartiles of RTE. (C) Kaplan-Meier cancer death in transplantation-free survival curves for patients according to quartiles of RTE.
See this image and copyright information in PMC

References

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