title: Pretransplant CD4 Count Influences Immune Reconstitution and Risk of Infectious Complications in Human Immunodeficiency Virus-Infected Kidney Allograft Recipients.
abstract: In current practice, human immunodeficiency virus-infected (HIV(+) ) candidates with CD4 >200 cells/mm(3) are eligible for kidney transplantation; however, the optimal pretransplant CD4 count above this threshold remains to be defined. We evaluated clinical outcomes in patients with baseline CD4 >350 and <350 cells/mm(3) among 38 anti-thymocyte globulin (ATG)-treated HIV-negative to HIV(+) kidney transplants performed at our center between 2006 and 2013. Median follow-up was 2.6 years. Rates of acute rejection and patient and graft survival were not different between groups. Occurrence of severe CD4 lymphopenia (<200 cells/mm(3) ), however, was more common among patients with a baseline CD4 count 200-349 cells/mm(3) compared with those transplanted at higher counts (75% vs. 30% at 4 weeks [p = 0.04] and 71% vs. 5% at 52 weeks [p = 0.001], respectively, after transplant). After adjusting for age, baseline CD4 count of 200-349 cells/mm(3) was an independent predictor of severe CD4 lymphopenia at 4 weeks (relative risk [RR] 2.6; 95% confidence interval [CI] 1.3-5.1) and 52 weeks (RR 14.3; 95% CI 2-100.4) after transplant. Patients with CD4 <200 cells/mm(3) at 4 weeks had higher probability of serious infections during first 6 months after transplant (19% vs. 50%; log-rank p = 0.05). These findings suggest that ATG must be used with caution in HIV(+) kidney allograft recipients with a pretransplant CD4 count <350 cells/mm(3) .
authors.affiliation: Department of Medicine, University of Miami Miller School of Medicine, Miami, FL.
authors.forename: J F
authors.initials: JF
authors.lastname: Suarez
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL.
authors.forename: R
authors.initials: R
authors.lastname: Rosa
authors.affiliation: Department of Medicine, University of Miami Miller School of Medicine, Miami, FL.
authors.forename: M A
authors.initials: MA
authors.lastname: Lorio
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL.
authors.forename: M I
authors.initials: MI
authors.lastname: Morris
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL.
authors.forename: L M
authors.initials: LM
authors.lastname: Abbo
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL.
authors.forename: J
authors.initials: J
authors.lastname: Simkins
authors.affiliation: Division of Nephrology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL.
authors.forename: G
authors.initials: G
authors.lastname: Guerra
authors.affiliation: Division of Nephrology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL.
authors.forename: D
authors.initials: D
authors.lastname: Roth
authors.affiliation: Division of Nephrology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL.
authors.forename: W L
authors.initials: WL
authors.lastname: Kupin
authors.affiliation: Division of Nephrology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL.
authors.forename: A
authors.initials: A
authors.lastname: Mattiazzi
authors.affiliation: Department of Surgery, University of Miami Miller School of Medicine and Miami Transplant Institute at the Jackson Memorial Hospital, Miami, FL.
authors.forename: G
authors.initials: G
authors.lastname: Ciancio
authors.affiliation: Department of Surgery, University of Miami Miller School of Medicine and Miami Transplant Institute at the Jackson Memorial Hospital, Miami, FL.
authors.forename: L J
authors.initials: LJ
authors.lastname: Chen
authors.affiliation: Department of Surgery, University of Miami Miller School of Medicine and Miami Transplant Institute at the Jackson Memorial Hospital, Miami, FL.
authors.forename: G W
authors.initials: GW
authors.lastname: Burke
authors.affiliation: Department of Surgery, University of Miami Miller School of Medicine and Miami Transplant Institute at the Jackson Memorial Hospital, Miami, FL.
authors.forename: M J
authors.initials: MJ
authors.lastname: Goldstein
authors.affiliation: Department of Surgery, University of Miami Miller School of Medicine and Miami Transplant Institute at the Jackson Memorial Hospital, Miami, FL.
authors.forename: P
authors.initials: P
authors.lastname: Ruiz
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL.
authors.forename: J F
authors.initials: JF
authors.lastname: Camargo
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000209:etiology*; D000328:Adult; D000368:Aged; D064591:Allografts; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000209:etiology*; D006085:Graft Survival / Q000276:immunology; D015658:HIV Infections / Q000150:complications* / Q000276:immunology / Q000628:therapy / Q000821:virology; D015497:HIV-1 / Q000276:immunology*; D006801:Humans; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000961:Antilymphocyte Serum
keywords: T cell biology; clinical research/practice; infection and infectious agents; infectious disease; kidney transplantation/nephrology; viral: human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)