Prolonged CD4 T cell lymphopenia increases morbidity and mortality after renal transplantation.

Abstract : 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 <300/mm3 and 36 (12%) died during follow-up. We observed a higher death rate in patients with CD4 T cell lymphopenia persisting for >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.
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Journal of the American Society of Nephrology, American Society of Nephrology, 2010, 21 (5), pp.868-75. 〈10.1681/ASN.2009090976〉
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Soumis le : mardi 18 mai 2010 - 11:20:13
Dernière modification le : jeudi 15 février 2018 - 08:48:15

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Didier Ducloux, Cécile Courivaud, Jamal Bamoulid, Bérengère Vivet, Aline Chabroux, et al.. Prolonged CD4 T cell lymphopenia increases morbidity and mortality after renal transplantation.. Journal of the American Society of Nephrology, American Society of Nephrology, 2010, 21 (5), pp.868-75. 〈10.1681/ASN.2009090976〉. 〈inserm-00484264〉

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