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Prolonged CD4 T Cell Lymphopenia Increases Morbidity and Mortality after Renal Transplantation

Authors :
Marina Deschamps
Christophe Ferrand
Philippe Saas
Pierre Tiberghien
Aline Chabroux
Jean-Marc Chalopin
Jamal Bamoulid
Jean-Michel Rebibou
Cécile Courivaud
Bérengère Vivet
Didier Ducloux
Interactions hôte-greffon-tumeur, ingénierie cellulaire et génique - UFC (UMR INSERM 1098) (RIGHT)
Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS [Bourgogne-Franche-Comté])-Université de Franche-Comté (UFC)
Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)
Service d'urologie, andrologie et transplantation rénale
Hôpital Saint-Jacques-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)
Centre d'Investigation Clinique de Besançon (Inserm CIC 1431)
Université de Franche-Comté (UFC)
Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS [Bourgogne-Franche-Comté])
Service de nephrologie, dialyse et transplantation
Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)
Saas, Philippe
Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Franche-Comté (UFC)
Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS [Bourgogne-Franche-Comté])
Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Hôpital Saint-Jacques
Source :
Journal of the American Society of Nephrology, Journal of the American Society of Nephrology, American Society of Nephrology, 2010, 21 (5), pp.868-75. ⟨10.1681/ASN.2009090976⟩
Publication Year :
2010
Publisher :
Ovid Technologies (Wolters Kluwer Health), 2010.

Abstract

International audience; Prolonged CD4 T cell lymphopenia after administration of polyclonal anti-thymocyte globulins increases the rate of posttransplantation morbidity, but whether impaired immune reconstitution affects survival is unknown. We studied the effect of CD4 T cell lymphopenia on survival in 302 consecutive prevalent renal transplant recipients and the role of thymic function in CD4 T cell reconstitution and posttransplantation outcomes in 100 consecutive incident renal transplant recipients. We followed the prevalent cohort for a mean duration of 92 months. Of these 302 patients, 81 (27%) had persistent CD4 T cell counts 1 year (24.1 versus 7.6%; P < 0.001). Furthermore, in Cox regression analysis, CD4 T cell lymphopenia associated with a nearly five-fold risk for death (adjusted hazard ratio [HR] 4.63; 95% confidence interval [CI] 1.91 to 10.65; P = 0.001). In the incident cohort, we estimated thymic function by T cell receptor excision circles (TRECs) per 150,000 CD3+ cells, which predicted efficient CD4 T cell reconstitution. Higher pretransplantation TREC values associated with lower risks for cancer (adjusted HR 0.39; 95% CI 0.15 to 0.97; P = 0.046) and infection (HR 0.29; 95% CI 0.11 to 0.78; P = 0.013). In summary, prolonged polyclonal anti-thymocyte globulin-induced CD4 T cell lymphopenia is an independent risk factor for death. Determination of pretransplantation thymic function may identify patients at higher risk for CD4 T cell lymphopenia and posttransplantation morbidity, including cancer and infections.

Details

ISSN :
10466673 and 15333450
Volume :
21
Database :
OpenAIRE
Journal :
Journal of the American Society of Nephrology
Accession number :
edsair.doi.dedup.....fb8fe9e20067075f34c6aa8743dd2ec5
Full Text :
https://doi.org/10.1681/asn.2009090976