title: Kinetics of peripheral blood lymphocyte subpopulations predicts the occurrence of opportunistic infection after kidney transplantation.
abstract: Serial monitoring of peripheral blood lymphocyte subpopulations (PBLSs) counts might be useful in predicting post-transplant opportunistic infection (OI) after kidney transplantation (KT). PBLSs were prospectively measured in 304 KT recipients at baseline and post-transplant months 1 and 6. Areas under receiver operating characteristic curves were used to evaluate the accuracy of different subpopulations in predicting the occurrence of overall OI and, specifically, cytomegalovirus (CMV) disease. We separately analyzed patients not receiving (n = 164) or receiving (n = 140) antithymocyte globulin (ATG) as induction therapy. In the non-ATG group, a CD8(+) T-cell count at month 1 <0.100 × 10(3) cells/μl had negative predictive values of 0.84 and 0.86 for the subsequent occurrence of overall OI and CMV disease, respectively. In the multivariate Cox model, a CD8(+) T-cell count <0.100 × 10(3) cells/μl was an independent risk factor for OI (adjusted hazard ratio: 3.55; P-value = 0.002). In the ATG group, a CD4(+) T-cell count at month 1 <0.050 × 10(3) cells/μl showed negative predictive values of 0.92 for the subsequent occurrence of overall OI and CMV disease. PBLSs monitoring effectively identify KT recipients at low risk of OI, providing an opportunity for individualizing post-transplant prophylaxis practices.
authors.affiliation: Unit of Infectious Diseases, Hospital Universitario "12 de Octubre". Instituto de Investigación Hospital "12 de Octubre" (i+12). School of Medicine, Universidad Complutense, Madrid, Spain.
authors.forename: Mario
authors.initials: M
authors.lastname: Fernández-Ruiz
authors.forename: Francisco
authors.initials: F
authors.lastname: López-Medrano
authors.forename: Luis M
authors.initials: LM
authors.lastname: Allende
authors.forename: Amado
authors.initials: A
authors.lastname: Andrés
authors.forename: Ana
authors.initials: A
authors.lastname: García-Reyne
authors.forename: Carlos
authors.initials: C
authors.lastname: Lumbreras
authors.forename: Rafael
authors.initials: R
authors.lastname: San-Juan
authors.forename: José M
authors.initials: JM
authors.lastname: Morales
authors.forename: Estela
authors.initials: E
authors.lastname: Paz-Artal
authors.forename: José M
authors.initials: JM
authors.lastname: Aguado
mesh_terms: D000328:Adult; D000368:Aged; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D018414:CD8-Positive T-Lymphocytes; D003586:Cytomegalovirus Infections / Q000276:immunology; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D018655:Lymphocyte Count; D016131:Lymphocyte Subsets; D008875:Middle Aged; D009894:Opportunistic Infections / Q000276:immunology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000961:Antilymphocyte Serum
keywords: cytomegalovirus; kidney transplantation; lymphocytopenia; monitoring; opportunistic infection; peripheral blood lymphocyte subpopulations