TY - JOUR
T1 - Absolute lymphocyte count as marker of cytomegalovirus and allograft rejection
T2 - Is there a “Safe Corridor” after kidney transplantation?
AU - El Helou, Guy
AU - Lahr, Brian
AU - Razonable, Raymund
N1 - Publisher Copyright:
© 2020 Wiley Periodicals LLC
PY - 2021/4
Y1 - 2021/4
N2 - 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.
AB - 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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U2 - 10.1111/tid.13489
DO - 10.1111/tid.13489
M3 - Article
C2 - 33037728
AN - SCOPUS:85093505946
SN - 1398-2273
VL - 23
JO - Transplant Infectious Disease
JF - Transplant Infectious Disease
IS - 2
M1 - e13489
ER -