Inserm, UMR1098, Federation Hospitalo-Universitaire INCREASE, Besançon, France.
Univ. Bourgogne Franche-Comté, Faculté de Médecine et de Pharmacie, LabEx LipSTIC, Besançon, France.
Front Immunol. 2020 Jul 31;11:1653. doi: 10.3389/fimmu.2020.01653. eCollection 2020.
Accelerated thymic involution is a main feature of end-stage renal disease (ESRD)-associated immune senescence. Recent evidences suggest that ESRD-associated immune senescence is associated with adverse outcomes in dialysis patients. However, no study focused on the association between pre-transplant thymic function and patient survival after transplantation. We conducted a prospective, multicenter study to assess whether pre-transplant thymic function measured by recent thymic emigrants (RTE) may predict death after first kidney transplantation. Results were tested in a validation cohort. Nine hundred and sixty-seven incident kidney transplant recipients were included in the prospective study. Mean follow up was 5.1 + 2.9 years. Eighty two patients (8.5%) died during follow up. Lower RTE levels were associated with a higher risk of death (2.53; 95%CI, 1.54-4.39 for each decrease of 1 log in RTE; < 0.001). Cancer-related death was particularly increased in patients with low RTE levels (4.23; 95%CI, 1.43-12.13; = 0.007). One hundred and thirty-six patients having received a first kidney transplantation were included in the validation cohort. Lower TREC levels were associated with higher risk of death (1.90; 95%CI, 1.11-3.51 for each decrease of 1 log in RTE; = 0.025). RTE were not associated with death-censored graft loss. Pre-transplant thymic function is strongly associated with death after transplantation. Attempt to reverse ESRD-related thymic loss may prevent premature death.
加速的胸腺萎缩是终末期肾病（ESRD）相关免疫衰老的主要特征。最近的证据表明，ESRD 相关免疫衰老与透析患者的不良结局有关。然而，尚无研究关注移植前胸腺功能与移植后患者生存之间的关系。我们进行了一项前瞻性、多中心研究，以评估最近的胸腺迁出细胞（RTE）测量的移植前胸腺功能是否可以预测首次肾移植后的死亡。研究结果在验证队列中进行了测试。前瞻性研究纳入了 967 例初发性肾移植受者。平均随访时间为 5.1 + 2.9 年。82 例（8.5%）患者在随访期间死亡。较低的 RTE 水平与死亡风险增加相关（每降低 1 个 RTE 对数，风险比为 2.53；95%CI，1.54-4.39； < 0.001）。在 RTE 水平较低的患者中，癌症相关死亡的风险特别增加（4.23；95%CI，1.43-12.13； = 0.007）。验证队列中纳入了 136 例接受首次肾移植的患者。TREC 水平越低，死亡风险越高（每降低 1 个 RTE 对数，风险比为 1.90；95%CI，1.11-3.51； = 0.025）。RTE 与死亡相关的移植物丢失无关。移植前胸腺功能与移植后死亡密切相关。尝试逆转 ESRD 相关的胸腺丢失可能会预防过早死亡。
