From the Department of Pediatrics, Cruces University Hospital, Bilbao, Spain.
Exp Clin Transplant. 2022 Mar;20(3):258-264. doi: 10.6002/ect.2021.0410.
Currentimmunosuppressive treatments for kidney transplant recipients have improved graft viability at the expense of impaired immune surveillance. The tools for monitoring immune status in pediatric kidney transplant recipients have not been widely investigated. Better knowledge could help recognize over immunosuppression and allow implementation of individualized preventive strategies.
This retrospective and observational study included 28 pediatric kidney transplant recipients treated at a tertiary hospital. We measured peripheral blood lymphocyte subpopulations, immunoglobulins, immunosuppressivedrug levels, and viral loads. Reference analytical values for different age ranges were used to determine immune status. We recorded overall hospitalizations due to opportunistic infections and positive viral loads posttransplant.
We found hypogammaglobulinemia and lymphopenia in 19% and 41% of the patients, respectively. Peripheral blood lymphocyte subpopulations were below normal limits in one-third of the sample. These parameters were not related to the current number or plasma levels of immunosuppressive drugs. During follow-up, cytomegalovirus, Epstein-Barr virus, and BK virus viremias were detected in 60.7% of the patients. Admissions due to opportunistic infections happened in 57.1%, mainly related to severe viral disease (30%) or gastrointestinal infections (26.7%). Most occurred in younger transplant recipients and during the first 2 years posttransplant (73.3%). We found no significant relation between peripheral blood lymphocyte subpopulations and hospital admissions for opportunistic infections or positive viral loads during follow-up.
Recurrent hospitalizations for opportunistic infections and analytical disorders in the immune system suggested that secondary immunosuppression in pediatric kidney transplant recipients was frequent. Immunosuppression was not directly related to plasma drug levels or the number of immunosuppressive drugs. Thus, immune monitoring might be helpful in combination with immunosuppressant levels to assess immunosuppression status and to establish individualized preventive measures.
目前，肾移植受者的免疫抑制治疗虽然提高了移植物的存活率，但却损害了免疫监视。尚未广泛研究用于监测儿科肾移植受者免疫状态的工具。更好地了解免疫抑制状态有助于识别过度免疫抑制，并实施个体化的预防策略。
本回顾性观察研究纳入了在一家三级医院接受治疗的 28 例儿科肾移植受者。我们测量了外周血淋巴细胞亚群、免疫球蛋白、免疫抑制剂药物水平和病毒载量。使用不同年龄范围的参考分析值来确定免疫状态。我们记录了所有因机会性感染和移植后病毒载量阳性而住院的病例。
我们发现，19%的患者存在低丙种球蛋白血症，41%的患者存在淋巴细胞减少症。三分之一的样本外周血淋巴细胞亚群低于正常范围。这些参数与当前免疫抑制剂药物的数量或血浆水平无关。在随访期间，60.7%的患者出现巨细胞病毒、EB 病毒和 BK 病毒血症。57.1%的患者因机会性感染而住院，主要与严重病毒病（30%）或胃肠道感染（26.7%）有关。大多数感染发生在较年轻的移植受者中，且发生在移植后 2 年内（73.3%）。我们未发现外周血淋巴细胞亚群与因机会性感染或随访期间病毒载量阳性而住院之间存在显著相关性。
反复因机会性感染住院以及免疫系统的分析障碍提示儿科肾移植受者存在继发性免疫抑制。免疫抑制与血浆药物水平或免疫抑制剂药物的数量无直接关系。因此，免疫监测可能有助于结合免疫抑制剂水平来评估免疫抑制状态，并制定个体化的预防措施。
