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Pretransplant CD4 Count Influences Immune Reconstitution and Risk of Infectious Complications in Human Immunodeficiency Virus–Infected Kidney Allograft Recipients

2016; Elsevier BV; Volume: 16; Issue: 8 Linguagem: Inglês

10.1111/ajt.13782

1600-6143

José Francisco Suárez, Rossana Rosa, Marco A. Lorio, Michele I. Morris, Lilian M. Abbo, Jacques Simkins, Giselle Guerra, David Roth, Warren Kupin, Adela Mattiazzi, Gaetano Ciancio, L. J. Chen, George W. Burke, Michael J. Goldstein, Phillip Ruiz, José F. Camargo,

HIV Research and Treatment

In current practice, human immunodeficiency virus–infected (HIV+) candidates with CD4 >200 cells/mm3 are eligible for kidney transplantation; however, the optimal pretransplant CD4 count above this threshold remains to be defined. We evaluated clinical outcomes in patients with baseline CD4 >350 and <350 cells/mm3 among 38 anti–thymocyte globulin (ATG)–treated HIV-negative to HIV+ kidney transplants performed at our center between 2006 and 2013. Median follow-up was 2.6 years. Rates of acute rejection and patient and graft survival were not different between groups. Occurrence of severe CD4 lymphopenia (<200 cells/mm3), however, was more common among patients with a baseline CD4 count 200–349 cells/mm3 compared with those transplanted at higher counts (75% vs. 30% at 4 weeks [p = 0.04] and 71% vs. 5% at 52 weeks [p = 0.001], respectively, after transplant). After adjusting for age, baseline CD4 count of 200–349 cells/mm3 was an independent predictor of severe CD4 lymphopenia at 4 weeks (relative risk [RR] 2.6; 95% confidence interval [CI] 1.3–5.1) and 52 weeks (RR 14.3; 95% CI 2–100.4) after transplant. Patients with CD4 <200 cells/mm3 at 4 weeks had higher probability of serious infections during first 6 months after transplant (19% vs. 50%; log-rank p = 0.05). These findings suggest that ATG must be used with caution in HIV+ kidney allograft recipients with a pretransplant CD4 count 200 cells/mm3 are eligible for kidney transplantation; however, the optimal pretransplant CD4 count above this threshold remains to be defined. We evaluated clinical outcomes in patients with baseline CD4 >350 and <350 cells/mm3 among 38 anti–thymocyte globulin (ATG)–treated HIV-negative to HIV+ kidney transplants performed at our center between 2006 and 2013. Median follow-up was 2.6 years. Rates of acute rejection and patient and graft survival were not different between groups. Occurrence of severe CD4 lymphopenia (<200 cells/mm3), however, was more common among patients with a baseline CD4 count 200–349 cells/mm3 compared with those transplanted at higher counts (75% vs. 30% at 4 weeks [p = 0.04] and 71% vs. 5% at 52 weeks [p = 0.001], respectively, after transplant). After adjusting for age, baseline CD4 count of 200–349 cells/mm3 was an independent predictor of severe CD4 lymphopenia at 4 weeks (relative risk [RR] 2.6; 95% confidence interval [CI] 1.3–5.1) and 52 weeks (RR 14.3; 95% CI 2–100.4) after transplant. Patients with CD4 <200 cells/mm3 at 4 weeks had higher probability of serious infections during first 6 months after transplant (19% vs. 50%; log-rank p = 0.05). These findings suggest that ATG must be used with caution in HIV+ kidney allograft recipients with a pretransplant CD4 count <350 cells/mm3.