CD4(+) T Cell Lymphopenia Predicts Mortality from Pneumocystis Pneumonia in Kidney Transplant Patients.

BACKGROUND: Pneumocystis jirovecii pneumonia (PcP) remains a life-threatening opportunistic infection after solid organ transplantation, even in the era of Pneumocystis prophylaxis. The association between risk of developing PcP and low CD4(+) T cell counts has been well-established. However, it is unknown whether lymphopenia in the context of post-renal transplant PcP increases the risk of mortality. METHODS: We carried out a retrospective analysis of a cohort of kidney transplant patients with PcP (n=49) to determine the risk factors for mortality associated with PcP. We correlated clinical and demographic data with the outcome of the disease. For CD4(+) T cell counts we used the Wilcoxon rank sum test for in-hospital mortality and a Cox proportional-hazards regression model for 60-day mortality. RESULTS: In univariate analyses, high CRP, high neutrophils, CD4(+) T cell lymphopenia, mechanical ventilation and high acute kidney injury network stage were associated with in-hospital mortality following presentation with PcP. In a receiver-operator characteristic (ROC) analysis, an optimum cut-off of