Correlation analysis of the peripheral blood lymphocyte count and occurrence of pneumonia after lung transplantation

Xing He; Zeli Luo; Yicen Han; Jia Yu; Siyu Fang; Lu Guo

doi:10.1016/j.trim.2023.101822

Correlation analysis of the peripheral blood lymphocyte count and occurrence of pneumonia after lung transplantation

Transpl Immunol. 2023 Jun:78:101822. doi: 10.1016/j.trim.2023.101822. Epub 2023 Mar 13.

Authors

Xing He¹, Zeli Luo², Yicen Han³, Jia Yu¹, Siyu Fang⁴, Lu Guo⁵

Affiliations

¹ School of Clinical Medicine, Chengdu Medical College, Chengdu, China; Department of Pulmonary and Critical Care Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
² Department of Pulmonary and Critical Care Medicine, Wenjiang Hospital of Sichuan Provincial People's, Chengdu, China.
³ Department of Pulmonary and Critical Care Medicine, Chengdu Second People's Hospital, Chengdu, China.
⁴ Medical School of University of Electronic Science and Technology of China, Chengdu, China; Department of Pulmonary and Critical Care Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
⁵ Department of Pulmonary and Critical Care Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China. Electronic address: guoluhx@126.com.

PMID: 36921729
DOI: 10.1016/j.trim.2023.101822

Abstract

Background: Infections are the most common complication in patients after lung transplantation and the main cause of death at all stages after transplantation; therefore, awareness regarding the occurrence of infectious pneumonia after lung transplantation is vital. This study aimed to explore the correlation between the absolute lymphocyte and T-lymphocyte subpopulation counts in the peripheral blood and the occurrence of pneumonia after lung transplantation and to predict the risk of pneumonia development after lung transplantation.

Materials: Patients who underwent lung transplantation with long-term follow-up between June 2018 and December 2021 were prospectively included. The patients were divided into pneumonia and non-pneumonia groups. Demographic and clinical characteristics, and the levels of leukocytes, neutrophils, platelets, C-reactive protein (CRP), procalcitonin (PCT), serum albumin, peripheral blood T lymphocytes, and CD4+ and CD8+ T cells in the peripheral blood were measured in both groups.

Results: We included 22 patients with post-lung transplants in the analysis. Of the 104 collected samples, 26 (56.5%) were pathogenically positive, 16 (61.5%) had bacterial infections, 7 samples (26.9%) had fungal infections, and 8 (30.8%) had viral infections. Patients with pneumonia had higher levels of peripheral blood neutrophils (P = 0.01), platelets (P = 0.03), and CRP (P < 0.001) than did those without pneumonia. Logistic regression analysis showed that the levels of peripheral blood neutrophils, total T lymphocytes, CRP, and PCT were associated with the development of pneumonia after transplantation (P < 0.05), as documented by their area under the curve (AUC) values of 0.702, 0.792, 0.899, and 0.789, respectively. The AUC for the combined receiver operating characteristic curve for predicting the development of pneumonia was 0.943, with a sensitivity of 91.3% and specificity of 93.1%. There was no significant difference in T-lymphocyte counts in patients with lung transplants between the pneumonia and non-pneumonia groups who were treated with two anti-rejection agents. In contrast, the absolute lymphocyte, total T-lymphocyte, and CD4+ and CD8+ T-cell counts in patients who developed pneumonia after treatment with three anti-rejection agents were lower than those in patients who did not develop pneumonia (P < 0.05).

Conclusion: Bacterial pneumonia is more common after lung transplantation than after fungal or viral infections. Peripheral blood T-lymphocyte counts combined with neutrophil, CRP, and PCT levels had good predictive value for the development of pneumonia after lung transplantation. Monitoring of patients should be strengthened by implementing peripheral blood T-lymphocyte counts to improve the early identification and prevention of pneumonia after lung transplantation.

Keywords: Infection; Lung transplantation; Pneumonia; T lymphocytes.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

C-Reactive Protein / metabolism
Humans
Lung Transplantation*
Lymphocyte Count
Pneumonia, Bacterial* / epidemiology
Pneumonia, Bacterial* / etiology
Retrospective Studies
T-Lymphocyte Subsets

Substances

C-Reactive Protein