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Prolonged CD4 T Cell Lymphopenia Increases Morbidity and Mortality after Renal Transplantation
- 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.
- Subjects :
- Adult
Male
Nephrology
medicine.medical_specialty
[SDV.IMM] Life Sciences [q-bio]/Immunology
030232 urology & nephrology
Thymus Gland
030230 surgery
Gastroenterology
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
T-Lymphocyte Subsets
Clinical Research
Internal medicine
Humans
Medicine
Prospective Studies
Risk factor
T-Lymphocytopenia, Idiopathic CD4-Positive
Prospective cohort study
Kidney transplantation
Antilymphocyte Serum
business.industry
T-cell receptor excision circles
Hazard ratio
General Medicine
Middle Aged
medicine.disease
Kidney Transplantation
3. Good health
Transplantation
Immunology
[SDV.IMM]Life Sciences [q-bio]/Immunology
Female
France
Lymphocytopenia
business
Immunosuppressive Agents
Subjects
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