Lymphocyte subpopulations during cytomegalovirus disease in renal transplant recipients

Abstract

We have determined the number of circulating T, B and natural killer cells in renal transplant recipients in order to detect changes during cytomegalovirus (CMV) infections. Serial blood samples were taken from 61 patients on standard triple immunosuppression therapy (cyclosporin A, azathioprine and prednisone). Using two-color flow cytometry analysis, the absolute number of CD3+, CD4+, CD8+, CD19+, CD3+HLA-DR+ and CD16+56+ cells was determined. Fortyeight patients (78.7%) developed active CMV infection, and all of them subsequently recovered. Twenty of the infected patients (32.8%) presented symptoms compatible with CMV disease during the infectious process. The number of lymphocytes and their main subpopulations were normal before the onset of CMV disease. During the disease there was a decrease followed by a significant increase (P<0.005) in the number of CD3+, CD4+, CD8+ and CD3+HLA-DR+ cells. No significant changes were observed in natural killer cells or B lymphocytes during the disease. We conclude, as observed in all viremic patients recovering from infection, that recovery is associated with an increase in the number of T cell subsets. The monitoring of different lymphocyte subsets along with antigenemia can be extremely useful in the detection of patients at high risk of developing CMV symptoms, allowing the early introduction of antiviral therapy or the reduction of immunosuppression therapy. Correspondence

Choice of Immunosuppression Influences Cytomegalovirus DNAemia in Cynomolgus Monkey (Macaca fascicularis) Islet Allograft Recipients

“…Higher CMV incidence and infection was reported coincided with a significant reduction of CD3 + and CD4 + cells in AIDS patients (21,47) and in kidney transplant recipients (15,18). In this study we found that the numbers of WBC, lymphocytes, CD3 + , CD3 + CD4 + , CD3 + CD8 + , and CD20 + cells were drastically decreased in islet transplanted NHP after thymoglobulin treatment, with an even greater reduction in lymphocyte, T and B cells when combined thymoglobulin/fludarabine therapy was used.…”

Risk factors and outcomes of Pneumocystis pneumonia in solid organ transplant recipients: Impact of posttransplant lymphoproliferative disorder

“…4 CMV infection, as well as first-line CMV therapy, both may decrease lymphocyte counts and may be considered in conjunction with lymphopenia in assessing PJP risk. [17][18][19] Acute rejection requiring augmentation of immunosuppression was not associated with PJP in this study. This contrasts with other published reports which have described an association between rejection and PJP.…”

“…CMV infection was also borderline significant in our analysis but has been associated with PJP in past studies 4 . CMV infection, as well as first‐line CMV therapy, both may decrease lymphocyte counts and may be considered in conjunction with lymphopenia in assessing PJP risk 17–19 …”

Immunodeficiency and Thymoma: A Case Report on Good Syndrome, a Diagnosis Frequently Missed and Forgotten

“…To the best of our knowledge, there is only 1 reported case of concomitant CMV retinitis and bronchiectasis associated with GS [ 14 ]. It was reported that the number of lymphocytes, which was normal prior to the onset of CMV disease, decreased during the active phase of disease, followed by an increase in the lymphocyte count later during the recovery stage [ 15 ]. This was seen in our patient, whose ALC dropped during the CMV disease and subsequently recovered after the resolution of infection.…”