title: CD4 Count in HIV- Brain-Dead Donors: Insight into Donor Risk Assessment for HIV+ Donors.
abstract: BACKGROUND
  The Human Immunodeficiency Virus (HIV) Organ Policy Equity Act allows for transplantation of organs from HIV-infected individuals (HIV+), provided it is performed under a research protocol. The safety assessment of an organ for transplantation is an essential element of the donation process. The risk for HIV-associated opportunistic infections increases as circulating CD4+ lymphocytes decrease to less than 200 cells/μL; however, the numbers of circulating CD4+ cells in the HIV-negative (HIV-) brain-dead donor (BDD) is not known.
  
  
  METHODS
  Circulating T-lymphocyte subset profiles in conventional HIV- BDD were measured in 20 BDD in a clinical laboratory.
  
  
  RESULTS
  The mean age of the BDD cohort was 48.7 years, 95% were white and 45% were women. The average body mass index was 29.2 kg/m. Cerebrovascular accident (40%) was the most prevalent cause of death. Sixteen (80%) subjects had a CD4 count ≤441 cells/μL (lower limit of normal) and 11 (55%) had a CD4 count less than 200 cells/μL; 11 (55%) subjects had a CD8 count ≤125 cells/μL (lower limit of normal). CD4/CD8 ratio was below normal in 3 patients (normal, 1.4-2.6). No recipient had a recognized donor-associated adverse event.
  
  
  CONCLUSIONS
  Absolute numbers of CD4 and CD8 T-lymphocytes are commonly reduced after brain death in HIV- individuals. Thus, CD4 absolute numbers are an inconsistent metric for assessing organ donor risk, irrespective of HIV status.
authors.affiliation: 1 Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN. 2 Department of Procurement, LifeSource Upper Midwest Organ Procurement Organization, Minneapolis, MN.
authors.forename: Oscar Kenneth
authors.initials: OK
authors.lastname: Serrano
authors.forename: Scott
authors.initials: S
authors.lastname: Kerwin
authors.forename: William D
authors.initials: WD
authors.lastname: Payne
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Pruett
mesh_terms: D001926:Brain Death / Q000175:diagnosis / Q000276:immunology*; D018791:CD4 Lymphocyte Count; D016516:CD4-CD8 Ratio; D002423:Cause of Death; D046148:Donor Selection; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000276:immunology* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D014019:Tissue Donors