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 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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Author:Tilo FreiwaldORCiD, Stefan BüttnerORCiD, Nardos Tesfaye Cheru, Despina Avaniadi, Simon S. MartinORCiDGND, Christoph StephanORCiDGND, Rainer U. Pliquett, Aida Asbe-Vollkopf, Gundolf SchüttfortORCiDGND, Volkmar Jacobi, Eva HerrmannORCiDGND, Helmut GeigerGND, Ingeborg A. HauserGND
Parent Title (English):Clinical transplantation
Place of publication:Oxford [u.]
Document Type:Article
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
Issue:9, art. e13877
Page Number:10
First Page:1
Last Page:10
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.
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (English):License LogoCreative Commons - Namensnennung-Nicht kommerziell 4.0