Division of Pediatric Infectious Diseases, Department of Pediatrics, Federal University of Sao Paulo, Sao Paulo, Brazil.
Division of Neonatal Medicine, Department of Pediatrics, Federal University of Sao Paulo, Sao Paulo, Brazil.
Am J Transplant. 2015 Jun;15(6):1654-65. doi: 10.1111/ajt.13143. Epub 2015 Apr 1.
Children born to female kidney recipients are exposed to immunosuppressive drugs during gestation. Little is known about their immune system at birth or in the long term. Twenty-eight children born to female kidney recipients and 40 full-term children born to healthy mothers were evaluated. T, B, NK, NKT, γδT cells were assessed by flow cytometry and functional evaluation of T and dendritic cells after in vitro activation was performed at birth and at 8 months of age. At birth, infants born to female kidney recipients showed lower numbers of CD4+ T, NKT and intense reduction of B cells (median cells/mm(3) , transplant: 153.7 X control: 512.4; p < 0.001). There was also a reduced percentage of activated CD8+ T and of CD4+ regulatory T cells. Activated memory and exhausted memory B cells showed higher percentages among children exposed to immunosuppressors when compared to control group. At 8 months, most immune alterations were no longer observed, but four children still had low numbers of some lymphocyte subsets at this age. Children born to female kidney recipients had 4.351 (95% CI: 1.026-15.225; p = 0.046) higher risk of hospital admission in the first months of life-some, with severe clinical manifestations-than those born to healthy women.
儿童在母体内会暴露于女性肾移植受体服用的免疫抑制剂中。关于其出生时或出生后的免疫系统所知甚少。本研究评估了 28 名女性肾移植受体所生儿童和 40 名健康母亲所生足月儿童。通过流式细胞术评估 T、B、NK、NKT、γδT 细胞，体外激活 T 和树突状细胞后进行功能评估。出生时，女性肾移植受体所生婴儿的 CD4+T、NKT 细胞数量减少，B 细胞数量明显减少（中位数细胞数/mm³，移植：153.7×对照：512.4；p<0.001）。此外，CD8+T 细胞和 CD4+调节性 T 细胞的激活百分比也降低。与对照组相比，暴露于免疫抑制剂的儿童中激活的记忆 B 细胞和耗竭的记忆 B 细胞的百分比更高。8 个月时，大多数免疫异常已不再存在，但仍有 4 名儿童在这个年龄时某些淋巴细胞亚群数量仍较低。与健康女性所生儿童相比，女性肾移植受体所生儿童在生命最初几个月（有些表现出严重的临床表现）住院的风险高 4.351 倍（95%CI：1.026-15.225；p=0.046）。
