*Purpose: Delayed graft function (DGF) is a common event after RT that increases the risk of acute rejection and early graft loss. The impact of renal replacement therapies (HD vs. PD) on DGF risk and how they affect T cell responses are unclear.

*Methods: We compared incidence of DGF between kidney transplant recipients who were treated with HD vs. PD before transplant in our unit between Jan 2017 and Dec 2018. We next performed a flow-cytometric analyses of 15 T lymphocyte subpopulations, including intracellular staining for IFN-g and IL-17, before (T0), at the end (T1), and before the beginning of the following (T2) HD treatment (using polymethylmethacrylate, poliariletersulfone, or polifenilene membranes) in 35 HD patients and in 10 healthy subjects (Fig. 1A).

*Results: Incidence of DGF was significantly higher in HD (DGF in 52 of 139) than PD (DGF in 4 of 45) recipients (38.1% vs. 7.2%; P <0.05). We found a statistically significant increase in CD4+ T cells (FIg. 1B), resulting in a significant increased of CD4+/CD8+ T cell ratio (Fig 1C) at the end of the HD treatment. Both CD4+ (Fig 1B) and CD8+ (Fig. 1D) T cells had a significatively augmented proliferation after HD that returned to basal values at the time of the following HD session (Fig 1C). We did not find significative differences across the three HD techniques tested.

*Conclusions: HD is associated with increased incidence of DGF compared to PD. Singolar treatment promotes transient CD4+ and CD8+ T cells proliferation, suggesting its possible role in promoting DGF when performed nearly before RT.

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