Thymoglobulin-Associated Cd4+ T-Cell Depletion and Infection Risk in HIV-Infected Renal Transplant Recipients
| Autor: | J.T. Carter, Michelle E. Roland, Marc L. Melcher, Peter G. Stock, Laurie Carlson |
|---|---|
| Rok vydání: | 2006 |
| Předmět: |
Adult
CD4-Positive T-Lymphocytes Graft Rejection Male medicine.medical_specialty Opportunistic infection AIDS-Related Opportunistic Infections medicine.medical_treatment CD4-CD8 Ratio HIV Infections Gastroenterology Lymphocyte Depletion Prednisone Internal medicine medicine Humans Immunology and Allergy Pharmacology (medical) Risk factor Kidney transplantation Antilymphocyte Serum Transplantation Thymoglobulin business.industry Graft Survival Immunosuppression Middle Aged medicine.disease Kidney Transplantation CD4 Lymphocyte Count Immunology HIV-1 Female business Immunosuppressive Agents medicine.drug |
| Zdroj: | American Journal of Transplantation. 6:753-760 |
| ISSN: | 1600-6135 |
| DOI: | 10.1111/j.1600-6143.2006.01238.x |
| Popis: | HIV-infected patients are increasingly referred for kidney transplantation, and may be at an increased risk for rejection. Treatment for rejection frequently includes thymoglobulin. We studied thymoglobulin's effect on CD4+ T-cell count, risk of infection and rejection reversal in 20 consecutive HIV-infected kidney recipients. All patients used antiretroviral therapy and opportunistic infection prophylaxis. Maintenance immunosuppression consisted of prednisone, mycophenolate mofetil and cyclosporine. Eleven patients received thymoglobulin (7 for rejection and 4 for delayed/slow graft function) while 9 did not. These two groups were similar in age, gender, race, donor characteristics and immunosuppression. Mean CD4+ T-cell counts remained stable in patients who did not receive thymoglobulin, but became profoundly suppressed in those who did, decreasing from 475 +/- 192 to 9 +/- 10 cells/microL (p0.001). Recovery time ranged from 3 weeks to 2 years despite effective HIV suppression. Although opportunistic infections were successfully suppressed, low CD4+ T-cell count was associated with increased risk of serious infections requiring hospitalization. Rejection reversed in 6 of 7 patients receiving thymoglobulin. We conclude that thymoglobulin reverses acute rejection in HIV-infected kidney recipients, but produces profound and long-lasting suppression of the CD4+ T-cell count associated with increased risk of infections requiring hospitalization. |
| Databáze: | OpenAIRE |
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