Kidney Week

Abstract: SA-PO992

Lymphocyte Immune Assays for the Management of Immunosuppression of Kidney Transplant Patients in Sepsis

Session Information

• Transplantation: Clinical - 4
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2102 Transplantation: Clinical

Authors

• Bakhshiyeva, Emiliya, University Hospital Erlangen Department of Nephrology and Hypertension, Erlangen, Germany

Emiliya Bakhshiyeva

• Kranefuß, Marie, University Hospital Erlangen Department of Transfusion Medicine, Erlangen, Germany

Marie Kranefuß

• Schiffer, Mario, University Hospital Erlangen Department of Nephrology and Hypertension, Erlangen, Germany

Mario Schiffer, MD, DrMed, MBA

• Willam, Carsten, University Hospital Erlangen Department of Nephrology and Hypertension, Erlangen, Germany

Carsten Willam, MD

• Brox, Regine, University Hospital Erlangen Department of Transfusion Medicine, Erlangen, Germany

Regine Brox, PhD

• Kurzhagen, Johanna T., University Hospital Erlangen Department of Nephrology and Hypertension, Erlangen, Germany

Johanna T. Kurzhagen, MD

Background

Kidney transplanted (KT) patients are on high risk for infections including sepsis. However, by date there is no guideline on the management of immunosuppression in these patients in sepsis and management is based on clinical decision making with little evidence.
We therefore aim to study different lymphocyte immune assays as potential biomarkers in septic patients with and without IS.

Methods

T- and B-cell markers were examined in 3 groups of patients: Healthy controls (HC), patients with sepsis without IS and patients with sepsis with IS. Sepsis was diagnosed based on Sequential Organ Failure Assessment (SOFA) Score. Determination of T- and B-cell markers was performed at different time points of sepsis, at day 0, 3 and 7 using flow cytometry.

Results

Study participants were 69.8 (standard deviation, SD: ±18.6) years old in average. Mean SOFA-Score at baseline was 4.5 (±0.7) in patients without IS vs. 4 (±0.0) in patients with IS.
CD3+ lymphocytes and CD8+ T-cells were less frequent in both groups compared to HCs. However, patients with IS showed recovery by day 7. CD4+ T-cell frequency was decreased in patients with IS in comparison to patients without IS.
In CD4+ T-cells, expression of pro-inflammatory markers such as CD4+TNF-α+, CD4+IFN-γ+ and CD4+IL-17+ was reduced in patients with IS compared to patients without IS. The anti-inflammatory marker CD4+IL-10+ was downregulated in both groups compared to HCs.
CD8+IFN-γ+ cells were more upregulated, whereas CD8+IL17+ in patients with IS compared to patients without IS. CD8+IL10+ cells were downregulated and CD8+TNF-α+ showed no differences in both groups compared to HCs.
Expression of T-cell activation markers CD25 and CD71 declined over the course of sepsis in both groups compared to HCs. The B-cell activation marker CD86 showed less expression in patients with IS on d0. CFSE revealed no changes in proliferation in different groups.

Conclusion

Preliminary data show differences in T- and B-cell markers between immunosuppressed and non-immunosuppressed patients in different phases of sepsis. This may provide deeper understanding of lymphocyte function and potentially allow a more individualized management of immunosuppression in KT patients in sepsis in future.