CD4 T cell lymphopenia is bad!

A recent article in JASN 2010 May edition talks about the prolonged CD4 T cell loss seen with thymoglobulin.
They studied the mortality and morbidity associated with this prolonged effect.  They evaluated >300 patients and found that if after 1 year the CD4 T cell lymphopenia was present, it was an independent risk factor for death in these patients. They suggest evaluating pre transplant thymic function and identifying these high risk patients.
If you now look at the the KDIGO transplant guidelines, that came out late last year, anti CD20 are the standard and first line choice to be used for induction and not thymoglobulin. Perhaps centers who use thymo for all their patients should re consider this. It should be from a case by case base and not just a protocol of a center.
As we are seeing more and more long survivors of transplant, things like infection and cancer have to be kept in mind and avoid the imbalance to shift.

Nice article