TY  - JOUR
A1  - Freiwald, Tilo
A1  - Büttner, Stefan
A1  - Cheru, Nardos Tesfaye
A1  - Avaniadi, Despina
A1  - Martin, Simon S.
A1  - Stephan, Christoph
A1  - Pliquett, Rainer U.
A1  - Asbe-Vollkopf, Aida
A1  - Schüttfort, Gundolf
A1  - Jacobi, Volkmar
A1  - Herrmann, Eva
A1  - Geiger, Helmut
A1  - Hauser, Ingeborg A.
T1  - CD4+ T cell lymphopenia predicts mortality from Pneumocystis pneumonia in kidney transplant patients
T2  - Clinical transplantation
N2  - 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.
KW  - clinical immunology
KW  - immunosuppression
KW  - infection
KW  - lymphocytes
KW  - mortality risk
KW  - pneumocystis
KW  - renal transplantation
KW  - risk factors
KW  - survival
KW  - transplantation
Y1  - 2020
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/63841
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-638414
SN  - 1399-0012
N1  - 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.
VL  - 34
IS  - 9, art. e13877
SP  - 1
EP  - 10
PB  - Wiley-Blackwell
CY  - Oxford [u.]
ER  -