title: Thymic function, anti-thymocytes globulins, and cancer after renal transplantation.
abstract: BACKGROUND
  Prolonged CD4 T cell lymphopenia after polyclonal antithymocyte globulins (ATG) is associated with an increased rate of cancers. Here, we examined whether pre-transplant thymic function estimated by TREC levels is predictive of cancer occurrence following ATG treatment.
  
  
  METHODS
  The impact of TREC on cancer occurrence was analyzed in 115 consecutive incident renal transplant recipients having received ATG.
  
  
  RESULTS
  Mean follow-up was 7.5±2.6years. After ATG induction, patients with the lowest pre-transplant TREC values had lower post-transplant CD4(+) and CD4(+) CD45RA(+) CD45RO(-) T cell counts, and a higher frequency of T cells with a regulatory phenotype (CD127(+)CD4(+)CD25(+)Foxp3(+)). Log-transformed pre-transplant TREC values were significantly lower in patients who developed cancer after transplantation (p<0.0001). The cumulative incidence of cancer was higher in patients having the lowest pre-transplant TREC values (T1 [low]: 47.4%, T2 [medium]: 12.5%, and T3 [high]: 2.7%; p<0.0001). In multivariate analysis, pre-transplant TREC value was the only predictive factor of cancer (HR, 0.39; 95% CI, 0.16 to 0.97, for one log (TREC/10(6) PBMC); p=0.046).
  
  
  CONCLUSIONS
  Pre-transplant thymic function is associated with an increased rate of post-transplant cancer in patients having received ATG. Omitting ATG in recipients with low pre-transplant TREC values should be considered.
authors.affiliation: INSERM, UMR645, Besançon, F-25020, France. dducloux@chu-besancon.fr
authors.forename: Didier
authors.initials: D
authors.lastname: Ducloux
authors.forename: Jamal
authors.initials: J
authors.lastname: Bamoulid
authors.forename: Cécile
authors.initials: C
authors.lastname: Courivaud
authors.forename: Béatrice
authors.initials: B
authors.lastname: Gaugler
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: Christophe
authors.initials: C
authors.lastname: Borg
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 / Q000008:administration & dosage / Q000009:adverse effects*; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000139:chemically induced* / Q000453:epidemiology* / Q000276:immunology; D012189:Retrospective Studies; D013950:Thymus Gland / Q000276:immunology*; D014184:Transplantation, Homologous
chemical_list: D000961:Antilymphocyte Serum