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Malnutrition and immune cell subsets in children undergoing kidney transplantation.

Publication ,  Journal Article
Shaw, BI; Lee, H-J; Ettenger, R; Grimm, P; Reed, EF; Sarwal, M; Stempora, L; Warshaw, B; Zhao, C; Martinez, OM; MacIver, NJ; Kirk, AD; Chambers, ET
Published in: Pediatr Transplant
December 2022

BACKGROUND: Malnutrition, including obesity and undernutrition, among children is increasing in prevalence and is common among children on renal replacement therapy. The effect of malnutrition on the pre-transplant immune system and how the pediatric immune system responds to the insult of both immunosuppression and allotransplantation is unknown. We examined the relationship of nutritional status with post-transplant outcomes and characterized the peripheral immune cell phenotypes of children from the Immune Development of Pediatric Transplant (IMPACT) study. METHODS: Ninety-eight patients from the IMPACT study were classified as having obesity, undernutrition, or normal nutrition-based pre-transplant measurements. Incidence of infectious and alloimmune outcomes at 1-year post-transplantation was compared between nutritional groups using Gray's test and Fine-Gray subdistribution hazards model. Event-free survival was estimated by Kaplan-Meier method and compared between groups. Differences in immune cell subsets between nutritional groups over time were determined using generalized estimating equations accounting for the correlation between repeated measurements. RESULTS: We did not observe that nutritional status was associated with infectious or alloimmune events or event-free survival post-transplant. We demonstrated that children with obesity had distinct T-and B-cell signatures relative to those with undernutrition and normal nutrition, even when controlling for immunosuppression. Children with obesity had a lower frequency of CD8 Tnaive cells 9-month post-transplant (p < .001), a higher frequency of CD4 CD57 + PD1- T cells, and lower frequencies of CD57-PD1+ CD8 and CD57-PD1- CD8 T cells at 12-month transplant (p < .05 for all). CONCLUSIONS: Children with obesity have distinct immunophenotypes that may influence the tailoring of immunosuppression.

Duke Scholars

Published In

Pediatr Transplant

DOI

EISSN

1399-3046

Publication Date

December 2022

Volume

26

Issue

8

Start / End Page

e14371

Location

Denmark

Related Subject Headings

  • Surgery
  • Obesity
  • Malnutrition
  • Kidney Transplantation
  • Immunosuppression Therapy
  • Humans
  • CD8-Positive T-Lymphocytes
  • 3213 Paediatrics
  • 3202 Clinical sciences
  • 1114 Paediatrics and Reproductive Medicine
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Shaw, B. I., Lee, H.-J., Ettenger, R., Grimm, P., Reed, E. F., Sarwal, M., … Chambers, E. T. (2022). Malnutrition and immune cell subsets in children undergoing kidney transplantation. Pediatr Transplant, 26(8), e14371. https://doi.org/10.1111/petr.14371
Journal cover image

Published In

Pediatr Transplant

DOI

EISSN

1399-3046

Publication Date

December 2022

Volume

26

Issue

8

Start / End Page

e14371

Location

Denmark

Related Subject Headings

  • Surgery
  • Obesity
  • Malnutrition
  • Kidney Transplantation
  • Immunosuppression Therapy
  • Humans
  • CD8-Positive T-Lymphocytes
  • 3213 Paediatrics
  • 3202 Clinical sciences
  • 1114 Paediatrics and Reproductive Medicine