[CD4(+) T lymphocyte detection in renal transplant recipients and its clinical value for cytomegalovirus pneumonia treatment].

OBJECTIVE: To explore the clinical value of CD4(+)T lymphocyte detection in the treatment of cytomegalovirus(CMV) pneumonia following kidney transplantation. METHODS: From January 2005 to May 2008, 133 recipients of kidney transplantation were enrolled in this study. The number of CD4(+)T cells in peripheral blood was examined. According to the changes of CD4(+)T cell, immunosuppressive agents (CsA/FK506+MMF+Pred) were adjusted, and the effects of CMV pneumonia occurring were investigated. RESULTS: In the period of 45-72 day after renal transplantation, 36 cases were found to have significantly lower number of CD4(+)T cells than that before operation. Of the 133 recipients, 12(9.0%, 12/133) had severe pneumonia, during 58-118 days after operation, including 7 with acute respiratory distress syndrome(ARDS); 4 patients(33.3%, 4/12) died and 8(66.7%, 8/12) were cured. The incidence of CMV pneumonia(27.8%, 10/36) in the low- CD4(+)T cell recipients was significantly higher than that(2.1%, 2/97) in patients with normal T cell level(P<0.01). During the withdrawal of immunosuppressive agents, 34 patients had normal kidney function(serum creatinine 71-126 micromol/L), except 2 cases underwent mild acute rejection. In 24 non-pneumonia recipients, the number of CD4(+)T cell kept growing as the withdrawal, on 14, 21 day after the withdrawal increased markedly compared with that on 0 day. In 8 survival patients with CMV pneumonia, the number of CD4(+)T cell rose slowly,on 21 day after the withdrawal increased to the normal level. But in 4 non-survival patients, the number of CD4(+)T cell kept continuously in lower level. CONCLUSION: CMV pneumonia is associated with lower CD4(+)T cell level in kidney transplant recipients. Determination of CD4(+) T cell could reflect the status of cellular immunity and give directions of the withdrawal. Discontinuance of immunosuppressive agents in severe CMV pneumonia patients was safe. However, it may be helpful to guide the clinical treatment.