Journal
TRANSPLANT INTERNATIONAL
Volume 27, Issue 3, Pages 271-279Publisher
WILEY-BLACKWELL
DOI: 10.1111/tri.12249
Keywords
risk factors; lymphocytes; immunosuppression; kidney transplantation
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Funding
- Genzyme
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To describe long-term CD4(+) T-cell reconstitution after rabbit antithymocyte globulin (rATG) treatment and identify predictive factors following kidney transplantation. A single-center retrospective study analyzed lymphocyte subsets in rATG-treated kidney transplant recipients (1986-2009). 589 patients were analyzed (maximum follow-up 21years). A comparator group (n=298) received an anti-IL-2 receptor monoclonal antibody. CD4(+) T-cell lymphopenia (<200/mm(3)) was present in 48.5%, 9.2%, 6.7%,2.0%, and 0% of patients at one, three, five, 10, and 20years post-transplant, respectively. CD4(+) T-cell count increased during the first 10years but remained below the pretransplant count even after 20years. At 1, 3, and 6months post-transplant, mean CD4(+) T-cell count was significantly lower in patients with CD4(+) T-cell lymphopenia at 12months versus patients without lymphopenia. On multivariate analyses, significant independent predictors for long-term impaired CD4 T-cell reconstitution were recipient age, pretransplant CD4(+) T-cell count, 12-month CD4(+) T-cell count, and tacrolimus or MMF therapy. Recipient age >40years was identified as a cutoff point. CD4(+) T-cell reconstitution following rATG treatment remains impaired even after 21years. Most risk factors for long-term impaired CD4(+) T-cell reconstitution may be evaluated pretransplant or are modifiable post-transplant.
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