Pretransplant CD4 Count Influences Immune Reconstitution and Risk of Infectious Complications in Human Immunodeficiency Virus–Infected Kidney Allograft Recipients. Issue 8 (4th April 2016)

• Record Type: Journal Article
• Authors: Suarez, J. F.; Rosa, R.; Lorio, M. A.; Morris, M. I.; Abbo, L. M.; Simkins, J.; Guerra, G.; Roth, D.; Kupin, W. L.; Mattiazzi, A.; Ciancio, G.; Chen, L. J.; Burke, G. W.; Goldstein, M. J.; Ruiz, P.; Camargo, J. F.
• Is Part Of: American journal of transplantation. Volume 16:Issue 8(2016:Aug.)
• Page Start: 2463
• Page End: 2472
• Publication Date: 2016-04-04
• Subjects: clinical research/practice -- infectious disease -- kidney transplantation/nephrology -- infection and infectious agents -- viral: human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) -- T cell biology; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.13782
• Languages: English
• ISSNs: 1600-6135

Abstract

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 . Abstract : In this single‐center retrospective cohort study, the authors show that anti‐thymocyte globulin–treated HIV‐positive kidney transplant recipients with a baseline CD4 count <350 cells/mm 3 have a higher risk of severe lymphopenia (CD4 <200 cells/mm 3 ), and associated nonopportunistic infections.