Features of the immune system response in pediatric renal transplant recipients

Abstract

Background. We need to take into account patients’ age and their immune system status to improve the results of kidney transplantation. Objective: to study the characteristics of the immune system response to a kidney transplant in pediatric recipients. Materials and methods. We performed a retrospective analysis of the cytometric study of peripheral blood lymphocytes subsets gated on CD45++ with the following antigens: CD3/4/8/45 (T-helper, T-cytotoxic), CD3/DR/19/45 (T-activated, B-cells), CD3/16/56/45 (T-NK- and NK-lymphocytes), CD38/45/19 (activated, total and B-lymphocytes), immunoregulatory index — CD4+/CD8+, and levels of immunoglobulin classes A, M, G in the blood serum in 38 adult and 16 pediatric recipients, who got the first kidney allograft from a living related donor in 2016–2019 at O.O. Shalimov National Institute of Surgery and Transplantology. Immune tests were performed before kidney transplantation, by the end of the first and sixth months after surgery. Results. Children have more pronounced signs of an immune system response to transplant and immunosuppressive therapy than adults. Some of the lymphocyte subsets in children show significantly stronger suppression by the end of the first month after surgery (relative number of CD45++ lymphocytes, relative and absolute number of CD3+19– T-lymphocytes, activated lymphocytes CD38+45+high and B-activated lymphocytes CD38+19+) and in six months (absolute CD45++ lymphocyte count, absolute and relative CD3–19+ B-lymphocyte count, T-activated CD3+DR+). Other lymphocyte subsets, on the contrary, show significantly greater increase in 30 days (absolute and relative CD3–19+ lymphocyte count) and 6 months (relative CD45++ lymphocyte count and T-lymphocytes CD3+19–, relative and absolute count of activated lymphocytes CD38+45+high) after transplantation. Some of the lymphocyte subsets in children recover to preoperative levels faster (relative numbers of CD45++ lymphocytes and T-helper cells CD4+8–). Conclusions. The analysis of the results shows that immune system response to kidney transplant in children and adults is somewhat different and is manifested by multidirectional changes in the absolute and relative number of lymphocyte subsets and immunoglobulin levels, which should be considered when choosing immunosuppressive therapy.