Infection is a major complication post-transplantation. Evaluating the immune system prior to transplant may allow better optimization of immunosuppression dose. T cell exhaustion has been described in chronic viral infections and cancer and results in a loss of T cell effector function (Wherry et al 2003 and Ye et al 2015). While dialysis patients are more prone to infection, it is unknown the prevalence of exhausted T cells on this population. A higher level of T cell exhaustion prior to the transplantation may allow the use of lower dose of immunosuppressive drugs, reducing the risk for infection. This pilot study investigates the status of the exhaustive phenotype in ESRD patients and hypothesize that T cells express higher levels of exhaustion markers.

Materials and methods

Healthy controls and patients on dialysis were included in this pilot study. Predialysis blood samples were obtained and analyzed by eight-color flow cytometry. The percentage of expression by CD4 cells from four exhaustion markers (PD-1, CTLA-4, TIM3 and LAG3) of the ESRD patients was determined and compared with healthy controls. Mann Whitney U test was used for the statistical analysis, with the level of significance p ≤ 0.05.

Results

The T cells from ESRD patients showed an upregulation of exhaustion markers. Percentage of CD4 cells that express PD1 was in the control group 11.8% and in the patients 23.3%. The percentage of LAG3, TIM3 and CTLA-4 expressed by CD4 cells increased from 1.17 to 1.52, 0.93 to 1.21, and 0.71 to 1.24, respectively.

Conclusion

This pilot study showed that ESRD patients have a higher expression of T cell exhaustion marker, in particular PD1. Whether this is associated with higher infection rate remains to be determined.

CITATION INFORMATION: Bastiaansen M, Uffing A, Riella L. Increased T Cell Exhaustion in Dialysis Patients. Am J Transplant. 2017;17 (suppl 3).

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