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

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 develo
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.
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Metadaten
Author:Tilo Freiwald, Stefan Büttner, Nardos Tesfaye Cheru, Despina Avaniadi, Simon S. Martin, Christoph Stephan, Rainer U. Pliquett, Aida Asbe-Vollkopf, Gundolf Schüttfort, Volkmar Jacobi, Eva Herrmann, Helmut Geiger, Ingeborg A. Hauser
URN:urn:nbn:de:hebis:30:3-638414
DOI:http://dx.doi.org/10.1111/ctr.13877
ISSN:1399-0012
Parent Title (English):Clinical transplantation
Publisher:Wiley-Blackwell
Place of publication:Oxford [u.]
Document Type:Article
Language:English
Date of Publication (online):2020/04/11
Date of first Publication:2020/04/11
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2022/03/09
Tag:clinical immunology; immunosuppression; infection; lymphocytes; mortality risk; pneumocystis; renal transplantation; risk factors; survival; transplantation
Volume:34
Issue:9, art. e13877
Pagenumber:10
First Page:1
Last Page:10
Note:
This research was supported in part by the Intramural Research Program of the NIH, The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Open access funding enabled and organized by Projekt DEAL.
HeBIS PPN:494572329
Institutes:Medizin
Dewey Decimal Classification:610 Medizin und Gesundheit
Sammlungen:Universitätspublikationen
Licence (English):License LogoCreative Commons - Namensnennung-Nicht kommerziell 4.0

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