In this cohort of patients, kidneys from deceased donors with ARF provided graft survival and renal function comparable with kidneys from donors without ARF 1 year after transplantation.

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Introduction: Infectious complications significantly increase morbidity and mortality after renal transplantation. The immunosuppression used is the main risk factor and relates directly to the incidence and severity of infectious events. Methods: This is a retrospective cohort study, which assessed the incidence of infections and their risk factors among 1,676 kidney transplant recipients during the first year of follow-up. Results: Infectious events were observed in 821 (49%) patients. The mean number of infectious episodes among patients with at least one episode was 2.3 (1 -12). The most prevalent infectious complications were as follows: urinary tract infection (31.3%); cytomegalovirus infection (12%); surgical wound infection (10.3%); herpes virus infection (9.1%); pulmonary infection (5.2%); and bloodstream infection (4.3%). Cold ischemia time and the use of deceased donor grafts were important risk factors for infectious episodes. Conclusions: Infections are highly prevalent in the first year following transplantation. The main infectious complication was urinary tract infection.

There is a growing number of elderly kidney transplant (Ktx) recipients. Elderly recipients present lower acute rejection rates but higher incidence of infection and malignancies. Aging per se seems to result in a shift to memory profile and chronic kidney disease (CKD) in premature immunological aging. Understanding aging and CKD effects on the immune system can improve elderly Ktx immunosuppression. We analyzed the effects of aging and CKD in the immune system, comparing healthy adults (HAd) (n=14, 26±2y), healthy elderly (HEld) (n=15, 79±7y), end stage renal disease (ESRD) adults (EnAd) (n=18, 36±7y) and ESRD elderly (EnEld) (n=31, 65±3y) prior to Ktx regarding their naïve, memory and regulatory T and B peripheral lymphocytes. Aging and ESRD presented additive effect decreasing absolute numbers of B and T-lymphocytes, affecting memory, naive and regulatory subsets without synergic effect. Both resulted in higher percentages of T memory subsets and opposing effects on regulatory T (TREG) subsets, higher percentage in aging and lower in ESRD. Combined effect of aging and ESRD also resulted in higher regulatory B cell percentages. In addition to global lymphopenia and TCD4+ memory shift in both aging and ESRD, aging shifts to an immunoregulatory profile, inducing a increase in TREG percentages, contrasting with ESRD that decreases TREGs. Differential immunosuppression regimens for elderly Ktx may be required. (ClinicalTrials.gov number: NTC01631058).

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Although recipients with ID have lower long-term patient survival, the equivalent graft survival rates support the indication of renal transplantation in such disability.

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