Kinetics of peripheral blood lymphocyte subpopulations predicts the occurrence of opportunistic infection after kidney transplantation

Serial monitoring of peripheral blood lymphocyte subpopulations (PBLSs) counts might be useful in predicting post‐transplant opportunistic infection (OI) after kidney transplantation (KT). PBLSs were prospectively measured in 304 KT recipients at baseline and post‐transplant months 1 and 6. Areas under receiver operating characteristic curves were used to evaluate the accuracy of different subpopulations in predicting the occurrence of overall OI and, specifically, cytomegalovirus (CMV) disease. We separately analyzed patients not receiving (n = 164) or receiving (n = 140) antithymocyte globulin (ATG) as induction therapy. In the non‐ATG group, a CD8⁺ T‐cell count at month 1 <0.100 × 10³ cells/μl had negative predictive values of 0.84 and 0.86 for the subsequent occurrence of overall OI and CMV disease, respectively. In the multivariate Cox model, a CD8⁺ T‐cell count <0.100 × 10³ cells/μl was an independent risk factor for OI (adjusted hazard ratio: 3.55; P‐value = 0.002). In the ATG group, a CD4⁺ T‐cell count at month 1 <0.050 × 10³ cells/μl showed negative predictive values of 0.92 for the subsequent occurrence of overall OI and CMV disease. PBLSs monitoring effectively identify KT recipients at low risk of OI, providing an opportunity for individualizing post‐transplant prophylaxis practices.     

外周血中血小板计数与前列腺体积相关性研究

目的:探讨外周血中炎症细胞计数与前列腺体积的关系,以期阐明良性前列腺增生(BPH)的机制。方法:严格遵守入组和排除标准募集了本中心自2015~2019年104例病理明确诊断为BPH的患者。分别采用一元和多元线性回归模型分析外周血中性粒细胞计数,血小板计数,中性淋巴比(NLR),血小板白细胞比值(PWR)及淋巴细胞单核细胞比值(LMR)等炎症指标与前列腺体积的相关性。结果:外周血中血小板计数(r=0.401,P<0.001),PWR(r=0.343,P<0.001)均与前列腺体积明显正相关,并与血清PSA水平正相关但与国际前列腺症状评分(IPSS)不相关;系统性炎症指标如NLR,LMR等与前列腺体积没有明确的相关性。结论:BPH人群里外周血中血小板计数是前列腺体积的重要预测因素,血小板可能在BPH的发生发展中扮演重要作用。     

肺移植术后T细胞亚群研究进展

T细胞是肺移植术后免疫应答的主要效应细胞,其细胞亚群水平对肺移植受者机体免疫状态具有重要影响。本文综述CD4^＋ T细胞、CD8^＋ T细胞和调节性T细胞的免疫学机制及其与肺移植术后原发性移植肺功能障碍、排斥反应、免疫耐受和感染等的关系,同时探讨监测肺移植术后T细胞亚群的临床意义。     

The peripheral lymphocyte count as an aid in the clinical staging of lung cancer.

The association between disease staging and peripheral lymphocyte count (PLC) was studied in 178 patients with histologically verified lung cancer. Mean PLC varied inversely with the stage of disease (p less than .01). The mean values were 2821, 2217, and 1594 for Stages I, II and III respectively. Thoretical normal distributions were generated about the mean peripheral lymphocyte count for each stage. Relative frequencies of lung cancer staging based on the PLC are estimated utilizing these curves.     

Mathematical modeling of peripheral blood neutrophil kinetics to predict CLAD after lung transplantation

BackgroundThe presence of neutrophils in the lung was identified as a factor associated with CLAD but requires invasive samples. The aim of this study was to assess the kinetics of peripheral blood neutrophils after lung transplantation as early predictor of CLAD.MethodsWe retrospectively included all recipients transplanted in our center between 2009 and 2014. Kinetics of blood neutrophils were evaluated to predict early CLAD by mathematical modeling using unadjusted and adjusted analyses.Results103 patients were included, 80 in the stable group and 23 in the CLAD group. Bacterial infections at 1 year were associated with CLAD occurrence. Neutrophils demonstrated a high increase postoperatively and then a progressive decrease until normal range. Recipients with CLAD had higher neutrophil counts (mixed effect coefficient beta over 3 years = +1.36 G/L, 95% Confidence Interval [0.99–1.92], p < .001). A coefficient of celerity (S for speed) was calculated to model the kinetics of return to the norm before CLAD occurrence. After adjustment, lower values of S (slower decrease of neutrophils) were associated with CLAD (Odds Ratio = 0.26, 95% Confidence Interval [0.08–0.66], p = .01).ConclusionA slower return to the normal range of blood neutrophils was early associated with CLAD occurrence.     

肝移植术后ImmuKnow细胞免疫功能与白细胞及T淋巴细胞计数的相关性研究

目的 探讨肝移植术后ImmuKnow细胞免疫功能测定值与白细胞分类计数和T淋巴细胞亚群计数的相关性,为临床提供一种价格低廉快速判断肝移植受者细胞免疫功能的方法.方法 选择49例行经典原位肝移植术受者术后2周至2个月内在无糖皮质激素应用情况下的外周血样本.分析ImmuKnow测定值与白细胞分类计数和T淋巴细胞亚群计数的相关性.并随机选择5例无激素免疫抑制的移植受者于术后2、3、4、6、8周分别重复检测上述指标,进一步验证其相关性.结果 白细胞总数与ImmuKnow ATP值相关性最高,相关系数为0.821;中性粒细胞计数与ImmuKnow ATP值相关性次之,相关系数为0.787;单核细胞计数相关系数虽然有统计学意义,但相关系数低于0.5.淋巴细胞计数和淋巴细胞亚群计数与ImmuKnow ATP值的相关性无统计学意义.5例无激素免疫抑制受者术后重复检测ImmuKnow ATP值的变化与细胞总数的变化呈正相关,相关系数均>0.5.结论 肝移植术后早期白细胞计数与CD4+T细胞ImmuKnow ATP值具有一定的正相关性,白细胞计数的变化,可以在一定程度上反映ImmuKnow ATP值的变化.

Abstract：

Objective To explore the relationship between peripheral differential blood count and ATP value in Cell CD4 + T tested by ImmuKnow method in liver transplants. Methods In this study 49recipients after classic orthotopic liver transplantation (OLT) were enrolled. In a period from two weeks to two months after transplantation when all were free of glucocorticoid. Blood were sent for WBC differential samples count and ATP value in Cell-CD4 + T tested by ImmuKnow method via SPSS17. 0 software. Five more samples were selected randomly for duplicated testing of the indices in Week2, 3, 4,6 and 8 after the transplanting operation to further verify the relativity. Results White blood cell count has the highest relativity with ImmuKnow ATP value at 0. 821. The 5 recipients were repeatedly tested for ImmuKnow ATP values that were found positively correlated to cell count with a coefficient of over 0. 5. Conclusions The peripheral leukocyte count in early stage after liver transplantation is in positive correlation with ATP value in Cell CD4 + T, and the changes of numeration of leukocyte reflect changes of ATP value.     

Predictive value of peripheral blood lymphocyte count in breast cancer patients treated with primary chemotherapy

Peripheral blood lymphocyte (PBL) count may reflect the immune status of cancer patients. We retrospectively analyzed the predictive and prognostic impact of baseline and post-chemotherapy PBL counts in a homogeneous group of 103 breast cancer patients treated with neoadjuvant chemotherapy (anthracyclines and taxanes). In univariate analysis, baseline PBL under 1500 × 10(6)/L (p = 0.013; hazard ratio [HR]: 2.80, 95%CI 1.24-6.61), and PBL decrease >200 × 10(6)/L after the first cycle of chemotherapy (p = 0.047; HR: 2.82, 95%CI 1.01-7.86) were significantly related to disease free survival. In multivariate analysis, both baseline PBL count less than 1500 × 10(6)/L (p = 0.034; HR: 3.32, 95%CI 1.09-10.02) and PBL decrease >200 × 10(6)/L after first cycle (p = 0.032; HR: 3.25, 95%CI 1.10-9.56) showed independent prognostic value for worse disease free survival. No effect was observed for overall survival. Our data support the relevance of pre- and post-chemotherapy PBL for breast cancer recurrence after neoadjuvant chemotherapy.     

肾移植术后早期外周血淋巴细胞因子mRNA表达研究

目的研究肾移植受者术后早期免疫功能状态。方法采用实时荧光定量PCR检测32例肾移植受者术前当天、术后第3、7、14、28天外周血淋巴细胞有关细胞因子mRNA表达;对2例急性排斥反应（AR）患者予以附加时间点检测。结果手术前当天IL-2、IL-10、IFN-γ和TGF-β1 mRNA分别为0．171、0．121、0．062和0．128;术后第3天分别为0．161、0．165、0．059和0．134;术后第7天分别为0．149、0．148、0．054和0．129;术后第14天分别为0．153、0．135、0．056和0．136;术后第28天分别为0．188、0．165、0．060和0．146。术后第3天,IL-10、TGF-β1 mRNA表达均较术前增强,IL-10表达增强更为明显（P〈0．01）,至第7天两者表达逐渐减弱至正常水平;术后IL-2、IFN-γmRNA表达减弱,第7天降至最低水平,此后逐渐回升直至正常。2例早期AR患者IL-2、IL-10、IFN-γ、TGF-β1 mRNA表达于AR发生前后均增强,以IL-2 mRNA表达增强最为明显。结论实时荧光定量PCR检测肾移植术后早期外周血淋巴细胞因子mRNA表达,可以了解肾移植受者术后早期免疫功能状态。Th1和Th2类细胞因子均可能在AR的发生发展中发挥重要作用。     

Time-dependent lymphocyte count after transplantation is associated with higher risk of graft failure and death

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异体手移植术后淋巴细胞亚群的早期监测

目的 探讨手移植患者术后外周血淋巴细胞亚群的变化和意义,以及如何通过CD_3~ 细胞数量的监测指导抗胸腺细胞球蛋白(antithymocyte globulin,ATG)的用量。方法 提取患者的外周血细胞,加入三荧光和双荧光标记的鼠抗人单克隆抗体CD_3/CD_4/CD_8,CD_3/CD(16 56),CD_3/HLA-DR,流式细胞分析仪进行测定。结果 术后一周内CD_3~ ,CD_4~ ,CD_8~ T细胞,活化T细胞[CD_3~ /CD_(16 56,CD_3~ /HLA-DR~ ],静止性T细胞[CD_3~ /CD_(16 56)~-,CD_3~ /HLA-DA~-明显下降,一周后除CD_~ 细胞比术前升高外,均恢复至术前水平;CD_4/CD_8比值持续呈低水平;B细胞(CD_3~-/HLA-DR~ )术后一周内升高,第10天逐渐下降至比术前略高水平;NK细胞(CD_3~-/CD_(16 56)~ )术后1天内显著升高,但第二天直线下降并维持在低水平。结论 两例异体手移植中的ATG剂量(2mg/kg/d)较为适宜,其CD_3~ 细胞数量的监控范围为0.1×10~9～0.4×10~9∧。提示T淋巴细胞亚群的监测有助于判断移植手的存活和诊断排斥反应的发生。免疫抑制剂对移植术后的T淋巴细胞亚群有明显的影响。     

Profiling of peripheral blood mononuclear cells does not accurately predict the bronchiolitis obliterans syndrome after lung transplantation

After lung transplantation (LTx), circulating mononuclear cell composition and their subsets may be predictive for the bronchiolitis obliterans syndrome (BOS). We investigated the cellular composition in patients developing BOS, or not, by analyzing peripheral blood taken at multiple time points after transplantation. PBMCs of 11 BOS and 39 non-BOS patients were analyzed by FACS for monocytes, dendritic cells, NK-, NKT-, B- and T cells as well as B- and T cell subsets. Analysis of blood samples taken monthly during the first year post-LTx showed that circulating NK, NKT and dendritic cell percentages were not indicative of BOS development, whereas increases in T cells, monocytes and lowered fractions of B cells were related to BOS development. B- and T cell subset analysis at month 5 post-LTx indicated that IgM+IgD − memory B cells and central memory CD8 + T cells were decreased, whereas NKT cells were increased in BOS patients compared to non-BOS patients. Prior to BOS diagnosis, the composition of specific mononuclear cells on a group level differs from patients remaining BOS free. However, given the overlap in percentages of cellular frequencies between the patient groups investigated, this analysis does not allow prediction or risk stratification for development of BOS in individual patients.     

肾移植术后肺孢子菌肺炎感染与CD4细胞计数的相关性

目的 分析肺孢子菌肺炎感染与CD4细胞计数的相关性。方法 对武汉大学人民医院器官移植科2019年4月至2020年3月收治的134例肾移植术后1年内患者,其中54例患者确诊感染肺孢子菌肺炎,检测CD4细胞数量。分析肺孢子菌肺炎发病率与CD4细胞计数是否具有相关性,再根据CD4细胞计数分成3组,以t检验分别分析两组患者的住院天数、吸氧天数、肺部炎症吸收天数等相关指标,探究CD4细胞计数与肺孢子菌肺炎转归与预后之间的关系。结果 134例病例中有53例患者感染肺孢子菌肺炎,3组患病率分别0.237、0.720、0.813。根据分组分别用住院时间、吸氧时间、病灶吸收时间两两进行t检验,P值分别为0.667、0.517、0.779、0.335、0.863、0.150、0.404、0.139、0.405。结果显示均无统计学差异。结论 在肾移植患者术后,肺孢子菌肺炎的发病率随着CD4细胞计数的减少而上升,但CD4细胞计数与疾病预后没有明显关联。     

The impact of the preoperative peripheral lymphocyte count and lymphocyte percentage in patients with colorectal cancer

Purpose

We evaluated the prognostic significance of the peripheral lymphocyte count and lymphocyte percentage, which reflect the preoperative immune status, in patients with colorectal cancer (CRC) and then compared their accuracy as predictors of the survival.

Methods

We retrospectively reviewed a database of 362 patients. We classified the patients into high lymphocyte count and low lymphocyte count groups. We also classified the patients into high lymphocyte percentage and low lymphocyte percentage groups.

Results

The 5-year relapse-free survival (RFS) rate in the high lymphocyte count group tended to be higher than that in the low lymphocyte count group. The 5-year overall survival (OS) rate in the high lymphocyte count group was significantly higher than that in the low lymphocyte count group. In contrast, the 5-year RFS and OS rates in the high lymphocyte percentage group were both significantly higher than those in the low lymphocyte percentage group. A multivariate analysis showed that the lymphocyte percentage was independently associated with the OS.

Conclusions

These findings suggest that the lymphocyte percentage is a good predictor of the OS and may be a stronger predictor of survival than the lymphocyte count in CRC patients.

     

Total lymphocyte count in peripheral blood of peritoneal dialysis patients: relationship to clinical parameters and outcome

BACKGROUND: Total lymphocyte count (TLC) is used as a nutritional status measurement. The impact of TLC on mortality in peritoneal dialysis (PD) patients is controversial. This study aimed at evaluating the effect of TLC on mortality, and assessing the relationship between TLC and nutritional status, anemia and erythropoietin (EPO) response, acute-phase response, dialysis adequacy and volume status in PD patients. METHODS: Seventy-three PD patients were monitored for 3 yrs from the beginning of the treatment. Data recorded for each patient included demographic features, comorbidity, TLC, blood biochemistry, systolic and diastolic blood pressures (BP), indices of dialysis adequacy and nutritional status, total fluid removal and mortality. Adjusted mortality risk for TLC was estimated using the Cox's regression models composed by TLC and one covariate having a value p<0.05 in univariate analysis. RESULTS: The 3-yr patient survival rates were significantly different among the TLC quartiles. The adjusted TLC was found, generally, to be a significant predictor of death in reduced Cox's models, except in models composed of TLC and total fluid removal or serum albumin. The receiver operating characteristics (ROC) analysis demonstrated that TLC provided a significant prediction of mortality. TLC correlated positively to total fluid removal, serum albumin, triglyceride and hematocrit, and negatively correlated to BP, high peritoneal transport and EPO-need. It did not correlate to other measures of nutritional status, dialysis adequacy and acute-phase response. Fluid removal and serum triglyceride were independent predictors of TLC in multivariate analysis. CONCLUSIONS: Our findings suggest that TLC can be used as a simple prognostic tool in PD patients; however, the association between TLC and mortality is confounded by other prognostic factors. Volume status could be a more important factor affecting the TLC than nutritional status.     

Effect of induction therapy on peripheral blood lymphocytes after lung transplantation: A multicenter international study

IntroductionLymphocytes, which are targeted by immunosuppressive therapies, may be influenced by induction and recipient characteristics. The objective of this study was to evaluate the influence of induction therapy on lymphocyte kinetics after lung transplantation (LTx) according to the recipient characteristics and allograft outcomes.MethodsWe retrospectively collected total lymphocyte counts from peripheral blood, which was monitored before and after transplantation (days 7, 14, 30, 90, 180, 365 and 730) in patients from 3 different lung transplant centers in Europe who encountered different induction strategies (no induction, anti-thymocyte globulins and basiliximab).ResultsA total of 164 recipients were included: 50 patients who did not receive induction therapy and 114 patients who received induction therapy (57 with anti-thymocyte globulins and 57 with basiliximab). The pre-transplant lymphocyte levels and induction therapy were associated with higher lymphocyte differences between pre-transplantation and day 7 (p < .001). The lymphocyte reconstitution was correlated with the pre-transplant weight (+10 cells/μL/kg, 95%CI [+5; +15], p < 0.001), pre-transplant lymphocyte level (−248 cells/μL, 95%CI [−368; −127] between low and high level recipients, p < 0.001), induction therapy with anti-thymocyte globulins (−636 cells/μL, 95%CI [−797; −475], p < 0.001), and induction with basiliximab (−641 cells/μL, 95%CI [−801; −481], p < 0.001) compared with no induction. Age was associated with a delayed reconstitution at day 30 (−9 cells/μL/year, 95%CI [−17; −1], p = 0.04) and day 90 (−8 cells/μL/year, 95%CI [−16; −1], p = 0.04). One-year mortality was associated with a lower lymphocyte count (−325 cells/μL, 95%CI [−522; −128], p = 0.001) and a best predictive threshold of 1000 cells/μL at day 90.ConclusionThe blood lymphocyte count after LTx is associated with the pre-transplant lymphocyte level, age, weight and induction therapy and predicts one-year mortality.     

Partial resolution of acute interstitial pneumonia in native lung after single lung transplantation.

The case of a 49 year old man presenting with rapidly progressive interstitial lung disease is described. Radiological findings and the lung biopsy specimen were compatible with an acute interstitial pneumonia, as was the relentless clinical course culminating in hypoxic respiratory failure. After right single lung transplantation there was considerable improvement in lung function and radiographic clearing of disease in the native left lung.     

Nephrotic syndrome after allogeneic peripheral blood stem cell transplantation

Nephrotic syndrome has been rarely reported after hematopoietic stem cell transplantation. We report a patient who developed nephrotic syndrome after allogeneic peripheral blood stem cell transplantation for acute myelogenous leukemia. Renal biopsy was performed and immunofluorescence and light microscopy were compatible with minimal change disease. The patient was treated with cyclophosphamide and prednisolone. Complete remission was achieved after three months. Previous reported cases are discussed.