Thymoglobulin-associated Cd4+ T-cell depletion and infection risk in HIV-infected renal transplant recipients.

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.

• 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)

Chemical References

• Antilymphocyte Serum
• Immunosuppressive Agents

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