title: 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.
authors.affiliation: Institut National de la Santé Et de la Recherche Médicale, UMR645, Besançon, France. dducloux@chu-besancon.fr
authors.forename: Didier
authors.initials: D
authors.lastname: Ducloux
authors.forename: Cécile
authors.initials: C
authors.lastname: Courivaud
authors.forename: Jamal
authors.initials: J
authors.lastname: Bamoulid
authors.forename: Bérengère
authors.initials: B
authors.lastname: Vivet
authors.forename: Aline
authors.initials: A
authors.lastname: Chabroux
authors.forename: Marina
authors.initials: M
authors.lastname: Deschamps
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Rebibou
authors.forename: Christophe
authors.initials: C
authors.lastname: Ferrand
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Chalopin
authors.forename: Pierre
authors.initials: P
authors.lastname: Tiberghien
authors.forename: Philippe
authors.initials: P
authors.lastname: Saas
mesh_terms: D000328:Adult; D000961:Antilymphocyte Serum / Q000009:adverse effects*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000139:chemically induced / Q000401:mortality*; D011446:Prospective Studies; D016176:T-Lymphocyte Subsets; D018344:T-Lymphocytopenia, Idiopathic CD4-Positive / Q000139:chemically induced / Q000401:mortality*; D013950:Thymus Gland / Q000187:drug effects / Q000276:immunology
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents