title: Risk factors for impaired CD4+ T-cell reconstitution following rabbit antithymocyte globulin treatment in kidney transplantation.
abstract: To describe long-term CD4+ T-cell reconstitution after rabbit antithymocyte globulin (rATG) treatment and identify predictive factors following kidney transplantation. A single-center retrospective study analyzed lymphocyte subsets in rATG-treated kidney transplant recipients (1986-2009). 589 patients were analyzed (maximum follow-up 21 years). A comparator group (n=298) received an anti-IL-2 receptor monoclonal antibody. CD4+ T-cell lymphopenia (<200/mm3) was present in 48.5%, 9.2%, 6.7%,2.0%, and 0% of patients at one, three, five, 10, and 20 years post-transplant, respectively. CD4+ T-cell count increased during the first 10 years but remained below the pretransplant count even after 20 years. At 1, 3, and 6 months post-transplant, mean CD4+ T-cell count was significantly lower in patients with CD4+ T-cell lymphopenia at 12 months versus patients without lymphopenia. On multivariate analyses, significant independent predictors for long-term impaired CD4 T-cell reconstitution were recipient age, pretransplant CD4+ T-cell count, 12-month CD4+ T-cell count, and tacrolimus or MMF therapy. Recipient age>40 years was identified as a cutoff point. CD4+ T-cell reconstitution following rATG treatment remains impaired even after 21 years. Most risk factors for long-term impaired CD4+ T-cell reconstitution may be evaluated pretransplant or are modifiable post-transplant.
authors.affiliation: Department of Nephrology and Clinical Immunology, CHRU Tours, Tours, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Longuet
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Sautenet
authors.forename: Philippe
authors.initials: P
authors.lastname: Gatault
authors.forename: Gilles
authors.initials: G
authors.lastname: Thibault
authors.forename: Christelle
authors.initials: C
authors.lastname: Barbet
authors.forename: Jean-Frédérique
authors.initials: JF
authors.lastname: Marliere
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Halimi
authors.forename: Yvon
authors.initials: Y
authors.lastname: Lebranchu
authors.forename: Christophe
authors.initials: C
authors.lastname: Baron
authors.forename: Matthias
authors.initials: M
authors.lastname: Büchler
mesh_terms: D000328:Adult; D000818:Animals; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000961:Antilymphocyte Serum / Q000009:adverse effects* / Q000627:therapeutic use; D000077552:Basiliximab; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D018655:Lymphocyte Count; D008212:Lymphocyte Depletion / Q000009:adverse effects* / Q000379:methods; D008231:Lymphopenia / Q000209:etiology / Q000276:immunology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009894:Opportunistic Infections / Q000209:etiology / Q000276:immunology; D011817:Rabbits; D015375:Receptors, Interleukin-2 / Q000037:antagonists & inhibitors; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000911:Antibodies, Monoclonal; D000961:Antilymphocyte Serum; D015375:Receptors, Interleukin-2; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab
keywords: immunosuppression; kidney transplantation; lymphocytes; risk factors