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Journal of Transplantation
Volume 2013, Article ID 841430, 8 pages
Clinical Study

Circulating CD4+CD28null T Cells May Increase the Risk of an Atherosclerotic Vascular Event Shortly after Kidney Transplantation

Erasmus Medical Center, Department of Internal Medicine, Division of Nephrology & Transplantation, D414, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands

Received 26 June 2013; Accepted 29 August 2013

Academic Editor: Parmjeet Randhawa

Copyright © 2013 Michiel G. H. Betjes et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Proinflammatory CD4+ T cells without the costimulatory molecule CD28 (CD4+CD28null T cells) are expanded in patients with end-stage renal disease (ESRD) and associated with atherosclerotic vascular events (AVE). In a prospective study, the number of circulating CD4+CD28null T cells was established in 295 ESRD patients prior to receiving a kidney allograft. Within the first year after transplantation, an AVE occurred in 20 patients. Univariate analysis showed that besides a history of cardiovascular disease (CVDpos, HR 8.1, ), age (HR 1.04, ), dyslipidaemia (HR 8.8, ), and the % of CD4+CD28null T cells (HR 1.04 per % increase, 95% CI 1.00–1.09, ) were significantly associated with the occurrence of a posttransplantation AVE. In a multivariate analysis, only CVDpos remained a significant risk factor with a significant and positive interaction between the terms CVDpos and the % of CD4+CD28null T cells (HR 1.05, 95% CI 1.03–1.11, ). Within the CVDpos group, the incidence of an AVE was 13% in the lowest tertile compared to 25% in the highest tertile of % of CD4+CD28null T cells. In conclusion, the presence of circulating CD4+CD28null T cells is associated with an increased risk for a cardiovascular event shortly after kidney transplantation.