title: Pre-transplant end-stage renal disease-related immune risk profile in kidney transplant recipients predicts post-transplant infections.
abstract: BACKGROUND
  End-stage renal disease (ESRD) is associated with premature aging of the T-cell system. Nevertheless, the clinical significance of pre-transplant ESRD-related immune senescence is unknown.
  
  
  METHODS
  We studied whether immune risk phenotype (IRP), a typical feature of immune senescence, may affect post-transplant infectious complications. A total of 486 patients were prospectively studied during the first year post transplant. IRP was defined as positive cytomegalovirus serology with at least 1 of the following criteria: CD4/CD8 ratio <1 and/or CD8 T-cell count >90th percentile.
  
  
  RESULTS
  We found that 47 patients (9.7%) had pre-transplant IRP. IRP+ patients did not differ from IRP- patients for any clinical characteristics, but exhibited more pronounced immune senescence. Both opportunistic infections (43% vs. 6%, P < 0.001) and severe bacterial infection (SBI) (40% vs. 25%, P = 0.028) were more frequent in IRP(+) patients. In multivariate analysis, IRP was predictive of both opportunistic infection (hazard ratio [HR] 2.97 [95% confidence interval {CI} 1.53-5.76], P = 0.001), and SBI (HR 2.33 [95% CI 1.34-3.92], P = 0.008). Acute rejection rates were numerically much lower in IRP+ patients. A total of 418 patients (86%) had biological evaluation 1 year post transplant. Among 41 IRP+ patients, 35 (85%) remained IRP+ 1 year post transplant.
  
  
  CONCLUSIONS
  Pre-transplant IRP is associated with an increased risk of post-transplant infection.
authors.affiliation: INSERM, UMR1098, Federation Hospitalo-Universitaire INCREASE, Besançon, France.|Faculté de Médecine et de Pharmacie, Université de Franche-Comté, Besançon, France.|Structure Fédérative de Recherche, SFR FED4234, Besançon, France.|Department of Nephrology, Dialysis, and Renal Transplantation, CHU Besançon, Besançon, France.
authors.forename: T
authors.initials: T
authors.lastname: Crepin
authors.affiliation: Department of Nephrology, Dialysis, and Renal Transplantation, CHU Besançon, Besançon, France.|CIC Biothérapie, INSERM CIC1431, CHU Besançon, Besançon, France.
authors.forename: E
authors.initials: E
authors.lastname: Gaiffe
authors.affiliation: INSERM, UMR1098, Federation Hospitalo-Universitaire INCREASE, Besançon, France.|Faculté de Médecine et de Pharmacie, Université de Franche-Comté, Besançon, France.|Structure Fédérative de Recherche, SFR FED4234, Besançon, France.|Department of Nephrology, Dialysis, and Renal Transplantation, CHU Besançon, Besançon, France.
authors.forename: C
authors.initials: C
authors.lastname: Courivaud
authors.affiliation: Faculté de Médecine et de Pharmacie, Université de Franche-Comté, Besançon, France.|Structure Fédérative de Recherche, SFR FED4234, Besançon, France.|Department of Nephrology, Dialysis, and Renal Transplantation, CHU Besançon, Besançon, France.
authors.forename: C
authors.initials: C
authors.lastname: Roubiou
authors.affiliation: INSERM, UMR1098, Federation Hospitalo-Universitaire INCREASE, Besançon, France.|Plateforme de Biomonitoring, EFS Bourgogne Franche-Comté, CIC 1431/UMR1098, Besançon, France.
authors.forename: C
authors.initials: C
authors.lastname: Laheurte
authors.affiliation: Department of Nephrology, Dialysis, and Renal Transplantation, CHU Strasbourg, Strasbourg, France.
authors.forename: B
authors.initials: B
authors.lastname: Moulin
authors.affiliation: Department of Nephrology, Dialysis, and Renal Transplantation, CHU Nancy, Nancy, France.
authors.forename: L
authors.initials: L
authors.lastname: Frimat
authors.affiliation: Department of Nephrology, Dialysis, and Renal Transplantation, CHU Reims, Reims, France.
authors.forename: P
authors.initials: P
authors.lastname: Rieu
authors.affiliation: Department of Nephrology, Dialysis, and Renal Transplantation, CHU Dijon, Dijon, France.
authors.forename: C
authors.initials: C
authors.lastname: Mousson
authors.affiliation: Department of Nephrology, Dialysis, and Renal Transplantation, CHU Kremlin-Bicêtre, Le Kremlin-Bicêtre, France.
authors.forename: A
authors.initials: A
authors.lastname: Durrbach
authors.affiliation: Department of Nephrology, Dialysis, and Renal Transplantation, CHU Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: A-E
authors.initials: AE
authors.lastname: Heng
authors.affiliation: INSERM, UMR1098, Federation Hospitalo-Universitaire INCREASE, Besançon, France.|Faculté de Médecine et de Pharmacie, Université de Franche-Comté, Besançon, France.|Structure Fédérative de Recherche, SFR FED4234, Besançon, France.|CIC Biothérapie, INSERM CIC1431, CHU Besançon, Besançon, France.|Plateforme de Biomonitoring, EFS Bourgogne Franche-Comté, CIC 1431/UMR1098, Besançon, France.
authors.forename: P
authors.initials: P
authors.lastname: Saas
authors.affiliation: INSERM, UMR1098, Federation Hospitalo-Universitaire INCREASE, Besançon, France.|Faculté de Médecine et de Pharmacie, Université de Franche-Comté, Besançon, France.|Structure Fédérative de Recherche, SFR FED4234, Besançon, France.|Department of Nephrology, Dialysis, and Renal Transplantation, CHU Besançon, Besançon, France.
authors.forename: J
authors.initials: J
authors.lastname: Bamoulid
authors.affiliation: INSERM, UMR1098, Federation Hospitalo-Universitaire INCREASE, Besançon, France.|Faculté de Médecine et de Pharmacie, Université de Franche-Comté, Besançon, France.|Structure Fédérative de Recherche, SFR FED4234, Besançon, France.|Department of Nephrology, Dialysis, and Renal Transplantation, CHU Besançon, Besançon, France.|CIC Biothérapie, INSERM CIC1431, CHU Besançon, Besançon, France.
authors.forename: D
authors.initials: D
authors.lastname: Ducloux
mesh_terms: D000328:Adult; D000368:Aged; D003587:Cytomegalovirus / Q000276:immunology*; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000517:prevention & control / Q000821:virology; D005260:Female; D006084:Graft Rejection / Q000276:immunology; D006801:Humans; D007668:Kidney / Q000601:surgery / Q000821:virology; D007676:Kidney Failure, Chronic / Q000276:immunology* / Q000821:virology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections; D011183:Postoperative Complications / Q000276:immunology*; D012307:Risk Factors; D013601:T-Lymphocytes / Q000276:immunology; D066027:Transplant Recipients
keywords: CMV; immune risk phenotype; immune senescence; infection; transplantation