Variation of CD4+ and CD8+ T lymphocytes as predictor of outcome in renal allograft recipients who developed acute respiratory distress syndrome caused by cytomegalovirus pneumonia

INTRODUCTION: We investigated the variation of CD4+ and CD8+ T lymphocytes in renal allograft recipients who developed acute respiratory distress syndrome (ARDS) caused by cytomegalovirus (CMV) infection and their relationship to patients outcome. METHODS: Twenty one cadaveric renal allograft recipients who developed ARDS caused by CMV infection were enrolled in this study. CD4+ and CD8+ T lymphocytes were examined in peripheral blood on five occasions: the admission day (day 0) to ICU as ARDS, day 5, day 10, day 15 in ICU, and discharge day. A value taken in the second month after transplantation was assumed to be the preinfection value. RESULTS: Among 13 surviving patients, the numbers of CD4+ and CD8+ T cells and their ratio increased as the patients recovered. The numbers of CD4+ T cells increased significantly on day 10, day 15, and at discharge day compared with day 0 (P < .05). The number of CD8+ T cells on discharge day and the ratios after day 10 were also significantly higher than those on day 0 (P < .05). In eight nonsurviving patients, the numbers of CD4+ and CD8+ T cells and their ratio was similar to day 0. The number of CD4+ and CD8+ cells after day 5 and their ratio after day 10 were significantly lower than those of survival group (P < .05). CONCLUSION: The variations of CD4+ and CD8+ T lymphocytes and their ratio are useful indicators of the severity of disease and the outcome of patients with CMV infections accompanying ARDS after renal transplantation. Nevertheless, it may be helpful to evaluate the efficiency of ongoing treatment methods in these patients.