Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Sep;34(9):e13877.
doi: 10.1111/ctr.13877. Epub 2020 Apr 30.

CD4+ T cell lymphopenia predicts mortality from Pneumocystis pneumonia in kidney transplant patients

Tilo Freiwald  1   2   3 , Stefan Büttner  1 , Nardos T Cheru  2 , Despina Avaniadi  1 , Simon S Martin  4 , Christoph Stephan  5 , Rainer U Pliquett  6 , Aida Asbe-Vollkopf  1 , Gundolf Schüttfort  5 , Volkmar Jacobi  4 , Eva Herrmann  7 , Helmut Geiger  1 , Ingeborg A Hauser  1
Affiliations

CD4+ T cell lymphopenia predicts mortality from Pneumocystis pneumonia in kidney transplant patients

Tilo Freiwald et al. Clin Transplant. 2020 Sep.

Abstract

Background: Pneumocystis jirovecii pneumonia (PcP) remains a life-threatening opportunistic infection after solid organ transplantation, even in the era of Pneumocystis prophylaxis. The association between risk of developing PcP and low CD4+ T cell counts has been well established. However, it is unknown whether lymphopenia in the context of post-renal transplant PcP increases the risk of mortality.

Methods: We carried out a retrospective analysis of a cohort of kidney transplant patients with PcP (n = 49) to determine the risk factors for mortality associated with PcP. We correlated clinical and demographic data with the outcome of the disease. For CD4+ T cell counts, we used the Wilcoxon rank sum test for in-hospital mortality and a Cox proportional-hazards regression model for 60-day mortality.

Results: In univariate analyses, high CRP, high neutrophils, CD4+ T cell lymphopenia, mechanical ventilation, and high acute kidney injury network stage were associated with in-hospital mortality following presentation with PcP. In a receiver-operator characteristic (ROC) analysis, an optimum cutoff of ≤200 CD4+ T cells/µL predicted in-hospital mortality, CD4+ T cell lymphopenia remained a risk factor in a Cox regression model.

Conclusions: Low CD4+ T cell count in kidney transplant recipients is a biomarker for disease severity and a risk factor for in-hospital mortality following presentation with PcP.

Keywords: clinical immunology; immunosuppression; infection; lymphocytes; mortality risk; pneumocystis; renal transplantation; risk factors; survival; transplantation.

PubMed Disclaimer

References

REFERENCES

    1. Schnuelle P, Lorenz D, Trede M, Van Der Woude FJ. Impact of renal cadaveric transplantation on survival in end-stage renal failure: evidence for reduced mortality risk compared with hemodialysis during long-term follow-up. J Am Soc Nephrol. 1998;9:2135-2141.
    1. Russell JD, Beecroft ML, Ludwin D, Churchill DN. The quality of life in renal transplantation-a prospective study. Transplantation. 1992;54:656-660.
    1. Keith DS, DeMattos A, Golconda M et al. Factors associated with improvement in deceased donor renal allograft function in the 1990s. J Am Soc Nephrol. 2005;16:1512-1521.
    1. Lamb KE, Lodhi S, Meier-Kriesche HU. Long-term renal allograft survival in the United States: a critical reappraisal. Am J Transplant. 2011;11:450-462.
    1. Briggs JD. Causes of death after renal transplantation. Nephrol Dial Transplant. 2001;16:1545-1549.

Publication types