Background: Chronic inflammation is often seen in pts w/ ESRD. HLA-sensitization may create or be driven by the cytokines responsible for chronic inflammation. Here we measure various immune cell levels by multi-color flow cytometry (FC) to determine relationships with chronic inflammation. Methods: Whole blood from 33 ESRD pts (11 HS, 22 NonHS) and 14 normal controls (NC) were submitted for FC analysis to measure the levels of lymphocytes (L), monocytes (Mo), CD4+ (CD4) & CD8+ (CD8) T, B, NK, naïve & memory (n, m), regulatory T (Treg) & B (Breg), T follicular helper (Tfh) cells and plasmablasts (PB). The results were expressed as cell% in parent cells; L & Mo% in leukocytes, CD4, CD8, B & NK% in total L, CD4n, CD4m, Treg & Tfh% in CD4, CD8n & CD8m% in CD8, and Bn, Bm, Breg & PB% in B. Results: ESRD pts showed larger variation in each cell% compared with NC (coeffient of variation [%CV] range among all cells tested, 12-88% vs. 9-46%). Among all cells tested, CD4 was significantly higher (49±12% v. 41±6%, p=0.02), CD4n lower (19±11 v. 32±11, p=0.004), CD4m higher (54±13 v. 40±11, p=0.003), Treg lower (3.3±1 v. 4.2±1, p=0.046) and Tfh higher (0.6±0.5 v. 0.3±0.2, p=0.02) in ESRD pts compared to NC. Among these cells, CD4 was significantly higher in non-HS than HS (53±10 v. 40±12, p=0.01), but no difference in other cell types was seen. The remaining cell populations, L (22±7 v. 25±6), Mo (6±2 v. 6±1), CD8 (26±11 v. 29±7), B (10±6 v. 12±4), NK (11±6 v. 12±5), CD8n (40±16 v. 42±14), CD8m (17±9 v. 15±7), Bn (61±17 v. 59±10), Bm (30±18 v. 32±12), Breg (6±5 v. 7±3) and PB (0.5±0.7 v. 0.7±1.2) were similar in ESRD pts and NC. Of interest, significantly higher CD8 was seen in HS compared to nonHS (32±11 v. 23±10, p=0.03). Conclusions: Immune cell profiles varied significantly between ESRD pts v. normal. Higher CD4m and lower CD4n% may indicate allo-reactive CD4+ memory cells. Treg population was also lower in ESRD pts compared to normal, which is consistent with our previous report, elevated IL-6 & IL-17A and down regulated TGFb1 in ESRD pts. Increased Tfh in ESRD pts suggest possible dysregulation of B cell and antibody production. Immune cell profiling of ESRD pts may help provide an additional measure of risk of allograft rejection in DSA negative pts prior to transplantation.

CITATION INFORMATION: Ge S., Chu M., Ortiz E., Vo A., Lovato D., Jordan S., Toyoda M. Assessment of Immune Cell Profiles in HLA-Sensitized (HS) & Non-HS Patients (Pts) with End Stage Renal Disease (ESRD) Am J Transplant. 2017;17 (suppl 3).

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