Absolute lymphocyte count: a predictor of recurrent cytomegalovirus disease in solid organ transplant recipients
BJ Gardiner, NE Nierenberg, JK Chow… - Clinical Infectious …, 2018 - academic.oup.com
BJ Gardiner, NE Nierenberg, JK Chow, R Ruthazer, DM Kent, DR Snydman
Clinical Infectious Diseases, 2018•academic.oup.comBackground Recurrent cytomegalovirus (CMV) disease in solid organ transplant recipients
frequently occurs despite effective antiviral therapy. We previously demonstrated that
patients with lymphopenia before liver transplantation are more likely to develop
posttransplant infectious complications including CMV. The aim of this study was to explore
absolute lymphocyte count (ALC) as a predictor of relapse following treatment for CMV
disease. Methods We performed a retrospective cohort study of heart, liver, and kidney …
frequently occurs despite effective antiviral therapy. We previously demonstrated that
patients with lymphopenia before liver transplantation are more likely to develop
posttransplant infectious complications including CMV. The aim of this study was to explore
absolute lymphocyte count (ALC) as a predictor of relapse following treatment for CMV
disease. Methods We performed a retrospective cohort study of heart, liver, and kidney …
Background
Recurrent cytomegalovirus (CMV) disease in solid organ transplant recipients frequently occurs despite effective antiviral therapy. We previously demonstrated that patients with lymphopenia before liver transplantation are more likely to develop posttransplant infectious complications including CMV. The aim of this study was to explore absolute lymphocyte count (ALC) as a predictor of relapse following treatment for CMV disease.
Methods
We performed a retrospective cohort study of heart, liver, and kidney transplant recipients treated for an episode of CMV disease. Our primary outcome was time to relapse of CMV within 6 months. Data on potential predictors of relapse including ALC were collected at the time of CMV treatment completion. Univariate and multivariate hazard ratios (HRs) were calculated with a Cox model. Multiple imputation was used to complete the data.
Results
Relapse occurred in 33 of 170 participants (19.4%). Mean ALC in relapse-free patients was 1.08 ± 0.69 vs 0.73 ± 0.42 × 103 cells/μL in those who relapsed, corresponding to an unadjusted hazard ratio of 1.11 (95% confidence interval, 1.03–1.21; P = .009, n = 133) for every decrease of 100 cells/μL. After adjusting for potential confounders, the association between ALC and relapse remained significant (HR, 1.11 [1.03–1.20]; P = .009).
Conclusions
Low ALC at the time of CMV treatment completion was a strong independent predictor for recurrent CMV disease. This finding is biologically plausible given the known importance of T-cell immunity in maintaining CMV latency. Future studies should consider this inexpensive, readily available marker of host immunity.
Oxford University Press