Low Pretransplant BMI/Weight and Changes in Posttransplant T Cell Exhaustion Levels Are Associated with Viremia/Viral Infection in Pediatric Kidney Transplantation in the First Post-Transplant Year – A Report from the IMPACT Study Consortium.
1Pediatrics, UCLA, LA, CA
2Rho, Chappel Hill, NC
3Pediatrics, Stanford Univ, Palo Alto, CA
4Pathology, UCLA, LA, CA
5Surgery, UCSF School of Medicien, SF, CA
6Pediatric Nephrolgoy, Children's Healthcare of Atlanta, Atlanta, GA
7Surgery, Duke University, Durham, NC.
Meeting: 2016 American Transplant Congress
Abstract number: D159
Keywords: Infection, Kidney transplantation, Pediatric, T cells
Session Information
Date: Tuesday, June 14, 2016
Session Name: Poster Session D: Kidney-Pediatrics
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Viral consequences of immunosuppression (IS) in pediatric(ped)kidney(kid)transplantation(Tx)patients(pts) are not fully known. We prospectively examined the immunologic and infectious (inf) history of 106 ped Tx pts during the first Tx year. Pts received institutional standard IS. There were no deaths and two Tx losses. 77 pts developed viremia and 24 rejection (rej) (18 with both). Using multivariable logistic regression, viremia and viral inf were not related to rej. Common viruses were CMV (24), EBV (36), BK (24) and, unexpectedly, JC (22). 30 pts had > 2 viremias, not all concurrent. 1/3 of pts with viremia developed viral inf. Pts who developed viral inf but not rej showed a mean weight percentile that was significantly lower at baseline (p=0.02) and 12 months (p =0.05) than pts with rej only or without rej/inf. Multivariable logistic regression controlling for age revealed that, in pts receiving induction therapy, pts receiving thymoglobulin had 68% lower odds of developing clinical viral inf (OR= 0.32; 95% CI [0.10, 1.02]) and pts receiving basiliximab had 82% lower odds of clinical viral inf (OR=0.18; 95% CI [0.05,0.60]) compared to pts receiving induction and/or maintenance daclizumab. Controlling for age, pts with viremia had significantly increased percentages of CD4+ exhaustion (exh) T cells (p= 0.006) over the first and lower levels of CD8+ exh T cells (p=0.0002). Among viremic pts, CD8+ exh T cells decreased even more in pts with lower BMI (p=0.003), We conclude that ped kid Tx is very often associated with viremia in the first tx year. Viral inf is not associated with rej, pt age, or thymoglobulin; it is associated with pre-transplant underweight, increased CD4+ T cell exh, and decreased CD8+ T cell exh.
CITATION INFORMATION: Ettenger R, Chin H, Grimm P, Kesler K, Reed E, Sarwal M, Warshaw B, Tsai E, Kirk A. Low Pretransplant BMI/Weight and Changes in Posttransplant T Cell Exhaustion Levels Are Associated with Viremia/Viral Infection in Pediatric Kidney Transplantation in the First Post-Transplant Year – A Report from the IMPACT Study Consortium. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Ettenger R, Chin H, Grimm P, Kesler K, Reed E, Sarwal M, Warshaw B, Tsai E, Kirk A. Low Pretransplant BMI/Weight and Changes in Posttransplant T Cell Exhaustion Levels Are Associated with Viremia/Viral Infection in Pediatric Kidney Transplantation in the First Post-Transplant Year – A Report from the IMPACT Study Consortium. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/low-pretransplant-bmiweight-and-changes-in-posttransplant-t-cell-exhaustion-levels-are-associated-with-viremiaviral-infection-in-pediatric-kidney-transplantation-in-the-first-post-transplant-year-n/. Accessed April 20, 2021.« Back to 2016 American Transplant Congress