Oxidative stress and 'monocyte reprogramming' after kidney transplant: a longitudinal study

Area of Science:

• Nephrology
• Immunology
• Transplantation Medicine

Background:

• Uremia in chronic kidney disease (CKD) is linked to increased oxidative stress (OS) and reduced monocyte HLA-DR expression.
• Successful kidney transplantation (KTx) is expected to normalize these parameters.

Purpose of the Study:

• To investigate OS and HLA-DR expression patterns after KTx.
• To explore the influence of renal function and immunosuppression regimens on these markers.

Main Methods:

• Advanced oxidation protein products (AOPP) and monocyte HLA-DR expression (%DR+) were measured in 30 KTx patients pre- and post-transplant, compared to 20 healthy controls.
• Patients were analyzed based on immunosuppressive drugs: cyclosporine (CyA), tacrolimus (FK), mycophenolate mofetil (MMF), and everolimus.

Main Results:

• Pre-KTx, patients had higher AOPP than controls. AOPP decreased post-KTx but remained elevated, returning to pre-KTx levels by 90 days.
• %DR+ was lower in KTx patients post-transplant, gradually returning to pre-KTx levels within a year, but never reaching control levels.
• Cyclosporine (CyA) was associated with higher AOPP and lower %DR+ compared to tacrolimus (FK) at 30 days. Mycophenolate mofetil (MMF) showed lower AOPP and higher %DR+ than everolimus.

Conclusions:

• Successful KTx partially reduces OS but does not normalize it, possibly due to persistent renal dysfunction and immunosuppression effects.
• Persistently low HLA-DR expression post-KTx may contribute to infectious complications.
• Immunosuppressive agents differentially impact OS and HLA-DR expression.