Abstract |
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 (p < 0.001). 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.
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Authors | J T Carter, M L Melcher, L L Carlson, M E Roland, P G Stock |
Journal | American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
(Am J Transplant)
Vol. 6
Issue 4
Pg. 753-60
(Apr 2006)
ISSN: 1600-6135 [Print] United States |
PMID | 16539632
(Publication Type: Controlled Clinical Trial, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
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Chemical References |
- Antilymphocyte Serum
- Immunosuppressive Agents
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Topics |
- AIDS-Related Opportunistic Infections
(complications, epidemiology, immunology)
- Adult
- Antilymphocyte Serum
(adverse effects, therapeutic use)
- CD4 Lymphocyte Count
- CD4-CD8 Ratio
- CD4-Positive T-Lymphocytes
(drug effects)
- Female
- Graft Rejection
(prevention & control)
- Graft Survival
(drug effects)
- HIV Infections
(complications)
- HIV-1
(isolation & purification)
- Humans
- Immunosuppressive Agents
(adverse effects, therapeutic use)
- Kidney Transplantation
(immunology, mortality)
- Lymphocyte Depletion
- Male
- Middle Aged
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