CMV Infection and Lymphopenia: Warning Markers of Pneumocystis Pneumonia in Kidney Transplant Recipients

被引:1
作者
Eberl, Isabelle [1 ]
Binquet, Christine [2 ,3 ]
Guilloteau, Adrien [4 ]
Legendre, Mathieu [5 ]
Dalle, Frederic [6 ,7 ]
Piroth, Lionel [1 ,2 ,3 ]
Tinel, Claire [5 ,8 ]
Blot, Mathieu [1 ,2 ,3 ,9 ]
机构
[1] Dijon Bourgogne Univ Hosp, Dept Infect Dis, Dijon, France
[2] Univ Bourgogne, INSERM, CIC 1432,CHU Dijon Bourgogne, Module Epidemiol Clin, Dijon, Bourgogne, France
[3] Univ Burgundy, LabEx LipST, Dijon, France
[4] Dijon Bourgogne Univ Hosp, Cote dOr Hemopathy Registry RHEMCO, Dijon, France
[5] Dijon Bourgogne Univ Hosp, Dept Nephrol & Kidney Transplantat, Dijon, France
[6] Dijon Bourgogne Univ Hosp, Dept Parasitol Mycol, Dijon, France
[7] UMR PAM Univ Bourgogne Franche Comte, AgroSup Dijon, Equipe Vin Aliment Microbiol Stress Grp Interact C, F-21078 Dijon, France
[8] Univ Bourgogne Franche Comte UBFC, EFS BFC, Inserm UMR1098, RIGHT, Besancon, France
[9] Univ Burgundy, INSERM Res Ctr LNC, Lipness Team, UMR1231 & LabEx LipST, F-21078 Dijon, France
关键词
kidney transplantation; pneumonia; lymphopenia; pneumocystis; CMV; RISK-FACTORS; JIROVECII PNEUMONIA;
D O I
10.3389/ti.2024.12192
中图分类号
R61 [外科手术学];
学科分类号
摘要
Pneumocystis pneumonia (PcP) remains life-threatening in kidney transplant recipients (KTR). Our study investigated risk factors one-year before PcP. We conducted a monocentric, case-control study including all KTR at the Dijon University Hospital (France) with a diagnosis of PcP between 2005 and 2022 (cases), and matched control KTR with no history of PcP (3 controls/case). Among all 1,135 KTR, 57 cases (5%) and 169 matched-controls were included. PcP was associated with 18% mortality. Compared to controls, cases were older, with a higher immunological risk, and CMV infection was more frequent in the year preceding the occurrence of PcP (23% vs. 4%; p < 0.001). As early as 1 year before PcP, lymphocyte counts were lower and serum creatinine levels were higher in cases, but immunosuppressive regimens were not significantly different. Multivariable analysis identified lymphocyte count, serum creatinine level, being treated by immunosuppressive therapy other than anti-rejection drugs, and CMV infection in the year preceding the time PcP as independently associated with the occurrence of PcP. PcP was associated with an increased risk of subsequent chronic rejection (27% vs. 3%; p = 0.001) and return to dialysis (20% vs. 3%; p = 0.002). The occurrence of CMV infection and a low lymphocyte count could redefine the indications for continuation or reinitiation of anti-Pneumocystis prophylaxis.
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页数:10
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