Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA.
Predictive Analytics and Comparative Effectiveness Center, Tufts Medical Center/Tufts University School of Medicine, Boston, Massachusetts, USA.
Clin Infect Dis. 2021 Dec 6;73(11):e3797-e3803. doi: 10.1093/cid/ciaa1800.
Cell-mediated immunity is a specific target of several medications used to prevent or treat rejection in orthotopic heart transplantation. Low absolute lymphocyte count (ALC) has potential to be a useful and accessible clinical indicator of overall infection risk. Though some studies have demonstrated this association in other transplant populations, it has not been assessed in heart transplant recipients.
A single-center retrospective cohort study examined adult heart transplant recipients transplanted between 2000 and 2018. The exposure of interest was ALC ≤0.75 × 103 cells/µL at 1 month posttransplant, and the primary endpoint was a composite outcome of infection (including cytomegalovirus [CMV], herpes simplex I/II or varicella zoster virus [HSV/VZV], bloodstream infection [BSI], invasive fungal infection [IFI]) or death occurring after 1 month and before 1 year posttransplant. A multivariable Cox proportional hazards model was created to control for confounders identified using clinical judgment and statistical criteria.
Of 375 subjects analyzed, 101 (27%) developed the composite outcome (61 CMV, 3 HSV/VZV, 19 BSI, 10 IFI, 8 deaths). Lymphopenia (ALC ≤0.75 × 103 cells/µL) at 1 month was associated with a >2-fold higher rate of the composite outcome (hazard ratio [HR], 2.26 [95% confidence interval {CI}, 1.47-3.46]; P < .001) compared to patients without lymphopenia at 1 month. After adjustment for confounding variables, the presence of lymphopenia remained statistically significantly associated with the composite outcome (HR, 1.72 [95% CI, 1.08-2.75]; P = .02).
ALC measured at 1 month after heart transplant is associated with an increased risk of infectious outcomes or death in the ensuing 11 months. This is a simple, accessible laboratory measure.
细胞介导的免疫是几种用于预防或治疗原位心脏移植排斥反应的药物的特定靶点。绝对淋巴细胞计数（ALC）低有可能成为一种有用且易于获得的临床整体感染风险指标。尽管一些研究已经在其他移植人群中证明了这种关联，但尚未在心脏移植受者中进行评估。
一项单中心回顾性队列研究检查了 2000 年至 2018 年间接受心脏移植的成年心脏移植受者。感兴趣的暴露是移植后 1 个月时 ALC≤0.75×103 细胞/μL，主要终点是 1 个月后至 1 年前发生的感染（包括巨细胞病毒[CMV]、单纯疱疹 I/II 或水痘带状疱疹病毒[HSV/VZV]、血流感染[BSI]、侵袭性真菌感染[IFI]）或死亡的复合结局。使用临床判断和统计标准确定混杂因素后，创建了多变量 Cox 比例风险模型进行控制。
在分析的 375 名受试者中，有 101 名（27%）发生了复合结局（61 例 CMV、3 例 HSV/VZV、19 例 BSI、10 例 IFI、8 例死亡）。移植后 1 个月时出现淋巴细胞减少症（ALC≤0.75×103 细胞/μL）与复合结局发生率增加 2 倍以上相关（风险比[HR]，2.26[95%置信区间{CI}，1.47-3.46]；P<.001）相比，1 个月时没有淋巴细胞减少症的患者。在调整混杂变量后，淋巴细胞减少症的存在与复合结局仍具有统计学显著相关性（HR，1.72[95% CI，1.08-2.75]；P=0.02）。
心脏移植后 1 个月时的 ALC 与随后 11 个月内感染结局或死亡的风险增加相关。这是一种简单、可获得的实验室测量方法。
