Cellular Immunity in Chronic Kidney Disease and Changes After Kidney Transplantation

Area of Science:

• Immunology
• Nephrology
• Transplantation Science

Background:

• Chronic kidney disease (CKD) significantly impacts cellular immunity.
• Understanding immune system changes throughout CKD stages and post-transplantation is crucial for patient management.

Purpose of the Study:

• To evaluate alterations in cellular immunity components from CKD stage V through long-term kidney transplantation (lKTx).
• To compare immune cell profiles in patients undergoing hemodialysis (HD), recent transplantation (rKTx), and lKTx against a healthy control group (CG).

Main Methods:

• Flow cytometry was used to analyze peripheral blood lymphocyte subpopulations.
• Key cell types assessed included total T-lymphocytes (CD4+, CD8+), CD28- T-cells, Natural Killer (NK) cells, and regulatory T-lymphocytes (Tregs).
• The study included patients with CKD-V, HD, rKTx, lKTx, and CG.

Main Results:

• Lymphocyte proportion decreased in CKD and HD patients but increased in rKTx and lKTx.
• CD4+ T-cell kinetics mirrored total lymphocytes, while CD8+ T-cells gradually increased from CG to lKTx.
• NK cells remained stable in CKD/HD, decreased in rKTx, and slightly increased in lKTx. Tregs declined until HD and showed suboptimal improvement post-transplantation.
• A significant increase in CD28- subpopulations (both CD4+ and CD8+) was observed in lKTx compared to HD.

Conclusions:

• Kidney transplantation can restore total lymphocytes and CD4+ T-cells but does not fully restore Tregs and NK cells.
• Long-term transplantation is associated with a substantial increase in CD28- T-lymphocyte subpopulations.