Cardiology Division, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
Sci Rep. 2021 Jan 14;11(1):1426. doi: 10.1038/s41598-020-80790-4.
Immunosuppressive therapy can decrease rejection episodes and increase the risk of severe and fatal infections in heart transplantation (HT) recipients. Immunosuppressive therapy can also decrease the absolute lymphocyte count (ALC), but the relationship between early post-transplant ALC and early cytomegalovirus (CMV) infection is largely unknown, especially in HT. We retrospectively analyzed 58 HT recipients who tested positive for CMV IgG antibody and received basiliximab induction therapy. We collected preoperative and 2-month postoperative data on ALC and CMV load. The CMV load > 1200 IU/mL was used as the cutoff value to define early CMV infection. Post-transplant lymphopenia was defined as an ALC of < 500 cells/μL at postoperative day (POD) #7. On POD #7, 29 (50.0%) patients had post-transplant lymphopenia and 29 (50.0%) patients did not. The incidence of CMV infection within 1 or 2 months of HT was higher in the post-transplant lymphopenia group than in the non-lymphopenia group (82.8% vs. 48.3%, P = 0.013; 89.7% vs. 65.5%, P = 0.028, respectively). ALC < 500 cells/μL on POD #7 was an independent risk factor for early CMV infection within 1 month of HT (odds ratio, 4.14; 95% confidence interval, 1.16-14.77; P = 0.029). A low ALC after HT was associated with a high risk of early CMV infection. Post-transplant ALC monitoring is simple and inexpensive and can help identify patients at high risk of early CMV infection.
免疫抑制疗法可以减少心脏移植（HT）受者的排斥反应发作，并增加严重和致命感染的风险。免疫抑制疗法还可以降低绝对淋巴细胞计数（ALC），但移植后早期 ALC 与早期巨细胞病毒（CMV）感染之间的关系在很大程度上尚不清楚，尤其是在 HT 中。我们回顾性分析了 58 例 CMV IgG 抗体阳性并接受巴利昔单抗诱导治疗的 HT 受者。我们收集了术前和术后 2 个月的 ALC 和 CMV 载量数据。将 CMV 载量＞1200 IU/mL 作为定义早期 CMV 感染的截止值。移植后淋巴细胞减少症定义为术后第 7 天（POD）#7 的 ALC＜500 个细胞/μL。在 POD#7，29 例（50.0%）患者出现移植后淋巴细胞减少症，29 例（50.0%）患者未出现。在移植后淋巴细胞减少症组中，在 HT 后 1 或 2 个月内发生 CMV 感染的发生率高于非淋巴细胞减少症组（82.8%比 48.3%，P=0.013；89.7%比 65.5%，P=0.028）。POD#7 的 ALC＜500 个细胞/μL 是 HT 后 1 个月内早期 CMV 感染的独立危险因素（比值比，4.14；95%置信区间，1.16-14.77；P=0.029）。HT 后低 ALC 与早期 CMV 感染的高风险相关。移植后 ALC 监测简单且经济实惠，可以帮助识别早期 CMV 感染风险高的患者。
