The age of the recipient and the ratio of CD4/CD8 in renal allografts influences the prognosis and the presenting time of the polyoma virus-associated nephropathy (PVAN)
B. Handan Ozdemir1, Eda Yilmaz Akcay1, F. Nurhan Ozdemir2, Esra Baskin3, Mehmet Haberal4.
1Department of Pathology, Baskent University, Ankara, Turkey; 2Department of Nephrology, Baskent University, Ankara, Turkey; 3Department of Pediatric Nephrology, Baskent University, Ankara, Turkey; 4Department of General Surgery, Division of Transplantation, Baskent University, Ankara, Turkey
Introduction: Uremia and hemodialysis (HD) are the primary pro-inflammatory conditions that can cause pre-mature immunological aging, virtually known to be unchanged after the transplantation. Drop in the CD4/CD8 ratio is the most critical consequence of immunological aging. Therefore, we aimed to understand the influence of the recipient's age and the ratio of CD4/CD8 on the prognosis and the presenting time of the PVAN in renal allografts.
Method: All 71 patients separated into three age groups [Group P <20 years (n:22), Group A: 20-50 years (n:30), Group B>50 years (n:19)]. Interstitial CD68, CD3, CD4, and CD8 positive cells graded. Patients were also separated into two groups in regards to the time of PVAN development [Group 1 (n:48) (≤12 months) and Group 2 (n: 23) (>12months)]. Follow-up biopsies were evaluated for interstitial fibrosis (IF).
Results: The mean interval between the PVAN and transplant was 17±22 months. The presenting time of PVAN was found early in Group P (8,9±6,8 months) and B patients (8,6±8,2 months) than Group A (28,8± 19,9 months) (p=0,001). Most of the patients in Group 1 were from Group P (n:19/22, 86,4%) and Group B (16/19, 84,2%) while only a few of them were from Group A (n:13/30, 43,3%) (p=0.001). The mean HD time was higher in Group P and B than in Group A (p=0.01). Group P (0,84±0,6) and Group B (0,77±0,6) patients showed lowest mean CD4/CD8 ratio compared to Group A (1,47± 0,9) (p<0.01). Also, the mean CD4/CD8 ratio was lowest in Group 1 recipients than group 2 (p<0.001). CD4/CD8 ratio negatively correlated with mean HD time, Pvl, viremia, and viruria (p<0.01) in all age groups. Total 43 patients developed IF, and 31 (43,7%) cases lost their graft. The mean CD4/CD8 ratio correlated positively with IF and graft loss (p<0.05).
Conclusion: Pediatric and old age groups have a lower CD4/CD8 ratio than adult patients aged 20 to 50 years. Pediatric and old age groups tend to show early onset of PVAN with an increased risk of IF development and graft loss associated with the low CD4/CD8 ratio.
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