Thymoglobulin‐Associated Cd4+ T‐Cell Depletion and Infection Risk in HIV‐Infected Renal Transplant Recipients

• Published in: American journal of transplantation Vol. 6; no. 4; pp. 753 - 760
• Main Authors: Carter, J.T., Melcher, M.L., Carlson, L.L., Roland, M.E., Stock, P.G.
• Format: Journal Article
• Language: English
• Published: Oxford UK Blackwell Publishing Ltd 01.04.2006; Blackwell
• Subjects: Adult; AIDS-Related Opportunistic Infections - complications; AIDS-Related Opportunistic Infections - epidemiology; AIDS-Related Opportunistic Infections - immunology; Antilymphocyte Serum - adverse effects; Antilymphocyte Serum - therapeutic use; Biological and medical sciences; CD4 Lymphocyte Count; CD4-CD8 Ratio; CD4-Positive T-Lymphocytes - drug effects; Female; Graft Rejection - prevention & control; Graft Survival - drug effects; HIV; HIV Infections - complications; HIV-1 - isolation & purification; Human immunodeficiency virus; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Infectious diseases; kidney transplant; Kidney Transplantation - immunology; Kidney Transplantation - mortality; Lymphocyte Depletion; Male; Medical sciences; Middle Aged; rejection; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; thymoglobulin; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Graft(material); Risk; Thymoglobulin; Transplantation; Homotransplantation; Epidemiology; Kidney; Surgery; T-Lymphocyte; Graft; Antithymocyte globulin; Immunopathology; Retroviridae; kidney transplant; AIDS; Immune deficiency; Lentivirus; Infection; Virus; Rejection; Depletion; Treatment; Urinary system; HIV; Viral disease; Risk factor; Human immunodeficiency virus
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2006.01238.x

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/μL (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.