Cellular Immunity in Chronic Kidney Disease and Changes After Kidney Transplantation

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.