The Inverted Renal CD4/CD8 Ratio Associated with the Development of Transplant Glomerulopathy and Arteriosclerosis
1Pathology, Baskent University, Ankara, Turkey, 2Nephrology, Baskent University, Ankara, Turkey, 3Transplantation, Baskent University, Ankara, Turkey
Meeting: 2019 American Transplant Congress
Abstract number: C46
Keywords: CD4, Graft survival, Kidney transplantation, Lymphocytes
Session Information
Session Name: Poster Session C: Kidney Complications: Late Graft Failure
Session Type: Poster Session
Date: Monday, June 3, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Inversion of the CD4/CD8 ratio (<2) identified as a hallmark of immunosenescence and an independent predictor of the development of arteriosclerosis and mortality in the general population. We aimed to assess the influence of an inverted renal CD4/CD8 ratio on the development of transplant glomerulopathy (TG) and transplant arteriosclerosis (TA).
*Methods: All indication and follow-up biopsies of 161 patients included in the study. Diabetic patients excluded from the study. Both interstitial and glomerular CD3, CD4, CD8 positive lymphocytes, leukocytes, and macrophages graded. Patients separated into two groups as Group 1(CD4/CD8 <2) and Group 2 (CD4/CD8 ≥2) in regards to the ratio of interstitial CD4 and CD8 positive lymphocytes. Follow-up biopsies analyzed for the development of TG and TA.
*Results: Among161 patients 72 were in Group1, and 89 were in Group 2. No significant difference found between the two groups in regards to cardiovascular risk factors such as age, gender, mean cholesterol level, and hypertension. The mean CD4/CD8 ratio found to decrease with the increasing time of hemodialysis (HD) (p<0.001). The development of ABMR, vascular rejection and the mean number of AR episodes found higher in Group1 (1,57±0,9) than Group 2 (0,7±0,7) (p<0.001). The mean CD4/CD8 ratio showed a negative correlation with glomerular and interstitial leukocyte and macrophage infiltration (p<0.001). Compared to Group 2, the development of TG and TA found higher in Group 1 (p<0.001). Also, the mean time of the development of TG and TA was seen earlier in Group1 than Group 2 (p<0.001). The mean value of the CD4/CD8 ratio was 1,1±0,8 and 1±0,7 for patients who developed TG an TA respectively, while it was 2,3±0,8 and 2,4±0,8 for patients who did not develop TG and TA respectively. Overall -10-year graft survival was 47% and 88% for Group 1 and Group 2 patients respectively (p<0.001).
*Conclusions: Uremia and HD associated proinflammatory condition underlies the impaired T-cell system by causing premature immunological aging and this immunosenescence virtually unchanged after transplant. We found that mean CD4/CD8 ratio found to decrease with the increasing time of HD and in turn predisposing early onset of TG and TA. We identified an inverted CD4/CD8 ratio as an immunological risk profile for the high incidence of AR, early onset of TG and TA. Thus, close monitoring must be done to these patients.
To cite this abstract in AMA style:
Ozdemir BH, Ozdemir FN, Atılgan AOk, Akcay E, Haberal M. The Inverted Renal CD4/CD8 Ratio Associated with the Development of Transplant Glomerulopathy and Arteriosclerosis [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/the-inverted-renal-cd4-cd8-ratio-associated-with-the-development-of-transplant-glomerulopathy-and-arteriosclerosis/. Accessed May 18, 2025.« Back to 2019 American Transplant Congress