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Updated: Feb 5, 2026
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
Cellular Immunity in Chronic Kidney Disease and Changes After Kidney Transplantation
Georgios Lioulios1, Eleni Moisidou2, Michalis Christodoulou2
1Department of Nephrology, 424 General Military Hospital, Thessaloniki, Greece.
Insights
Cellular immunity significantly changes in chronic kidney disease (CKD) patients. Kidney transplantation restores some immune cells, but not all, and increases specific T-cell subsets.
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.
Abstract:
This study evaluates changes in cellular immunity components, from chronic kidney disease stage V (CKD-V) to long-term transplantation (lKTx). We applied flow cytometry to determine total, CD4+, CD8+, CD28- T-lymphocytes, Natural killer cells (NK) and regulatory T-lymphocytes (Tregs), in peripheral blood of 56 patients with CKD-V, 207 patients on hemodialysis (HD), 149 recently transplanted (rKTx), 26 lKTx patients and 49 healthy volunteers as a control group (CG). Lymphocyte proportion decreased in CKD vs. CG [20.2 (14.4-25.8) vs. 29.7 (24.4-38.1)%, p < 0.001] without further deterioration in HD [19.9 (15.3-23.7)%, p = 0.83 vs. CKD-V] and increased in rKTx [24.7 (20-32.6)%, p < 0.001 vs. HD], and lKTx [25.5 (21.9-35)%, p = 0.16 vs. CG]. Similar kinetics were observed in CD4+ subpopulations, however CD8+ T-cells gradually increased from CG to lKTx. NK remained stable in CKD-V and HD, reduced in rKTx, and marginally increased in lKTx. Tregs gradually declined until HD and suboptimally improved with transplantation. CD28- subpopulations largely increased in lKTx, compared with HD [CD4+CD28-: 12.6 (4.7-27.6) vs. 6 (2.1-13.2)%, p = 0.006, CD8+CD28-: 68.4 (54.4-90.3) vs. 45.5 (28.4-58.9)%, p < 0.001], independently of age for CD8+CD28- (p = 0.33). Cellular immunity subpopulations show significant changes in the spectrum of CKD, with transplantation restoring total lymphocytes and CD4+ T-cells, but not Tregs and NK. LKTx was associated with a large increase in CD28- subpopulations.
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