Absolute lymphocyte count as marker of cytomegalovirus and allograft rejection: Is there a "Safe Corridor" after kidney transplantation?

被引:22
作者
El Helou, Guy [1 ,2 ]
Lahr, Brian [3 ]
Razonable, Raymund [1 ,4 ]
机构
[1] Mayo Clin, Div Infect Dis, Rochester, MN USA
[2] Univ Florida, Div Infect Dis & Global Med, Gainesville, FL 32611 USA
[3] Mayo Clin, Dept Hlth Sci Res, Rochester, MN USA
[4] Mayo Clin, William J Liebig Ctr Transplantat & Clin Regenera, Rochester, MN USA
关键词
CELL COSTIMULATORY PATHWAYS; DISEASE; INFECTION;
D O I
10.1111/tid.13489
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
The contrasting outcomes of lymphocyte manipulation after solid organ transplantation are allograft rejection and infections, commonly with cytomegalovirus (CMV). Peripheral blood absolute lymphocyte count (ALC) may serve as a predictive marker for these outcomes. Using a retrospective review of clinical and laboratory dataset, we aimed to determine whether a range of ALC (termed "safe ALC corridor") exists where CMV infection and rejection outcomes are minimal in a cohort of 381 kidney transplant recipients. In an extended Cox model using a time-dependent covariate for peripheral blood ALC, a value below the cut-off of 610 cells/uL was associated with the development of CMV infection both in the overall cohort (Hazard Ratio [HR] 2.25 (95% confidence internal [CI] 1.02-4.96;P = .043) and the subgroup of high-risk CMV D+/R- mismatch patients (HR 2.91 [95% CI 1.09-7.77];P = .033). In contrast, a time-dependent Cox analysis did not show any significant association between ALC and rejection (per IQR decrease, HR 1.2 [95% CI: 0.76-1.9];P = .434). Accordingly, a "safe ALC corridor" could not be defined. In conclusion, a low peripheral blood ALC (ie, threshold of 610 cells/uL) can be used to stratify the risk of CMV disease after kidney transplantation.
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页数:7
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