Kidney Transplantation and Cellular Immunity Dynamics: Immune Cell Alterations and Association with Clinical and Laboratory Parameters

Abstract

Background/Objectives: The purpose of this study was to evaluate numerical changes in immune cells after successful kidney transplantation and associate their recovery with clinical and laboratory factors. Methods: In 112 kidney transplant recipients, we performed flow cytometry to evaluate counts of CD4+, CD8+, and regulatory T cells (Tregs), as well as natural killer (NK) cells, before kidney transplantation (T0) and three (T3), six (T6), and twelve (T12) months later. The results were associated with the recipient's age, cold ischemia time (CIT), the type of donor, dialysis method and vintage, and graft function in one year. Results: Total and CD8+ T cell counts increased gradually one year post transplantation in comparison with pre-transplantation levels, whereas the number of CD4+ T cells and Tregs increased, and the number of NK cells decreased in the first three months and remained stable thereafter. The recipient's age was negatively correlated with total, CD4+, and Treg counts at T12, whereas CIT affected only total and CD4+ T cell count. Moreover, recipients receiving kidneys from living donors presented better recovery of all T cell subsets at T12 in comparison with recipients receiving kidneys from cadaveric donors. Patients on peritoneal dialysis had increased numbers of total and CD8+ T cells, as well as NK cells. Finally, estimated glomerular filtration rate was positively correlated with Treg level and potentially CD4+ T cells one-year post transplantation. Conclusions: Successful kidney transplantation results in the recovery of most T cell subsets. Lower recipient age and better graft function contribute to increased T cell counts, whereas donor type and dialysis modality are the most important modifiable factors for optimal immune recovery.

Keywords: T cells; cold ischemia time; kidney transplantation; natural killers; regulatory T cells.

Figure 1

Gating strategy of T cell subsets.

Figure 2

Changes in absolute count (A,C,E,G,I) and percentage (B,D,F,H,J) of cell subsets during the 12-month follow-up of total and percentage T cells, CD4+ cells, CD8+ cells, natural killer cells, and regulatory T cells, respectively. Double arrows denote statistical significance; straight lines: p < 0.008; dotted lines 0.008 < p < 0.05 (not significant after Bonferroni correction).

Figure 3

Changes of T cell subset counts from pretransplant levels (T0) to levels 12 months after transplantation (T12), after logarithmic transformation, according to estimated glomerular filtration rate (eGFR) at T12. (A). Total T cells, (B). CD4+ T cells, (C). CD8+ T cells, (D). Natural Killer cells, (E). Regulatory T cells.