[CIS PIDD] [cis-pidd] AW: Low T-cells post-Heart Transplant

Wed Apr 26 00:33:05 EDT 2017

Joe,

I agree with Fabian.  Our experience in patients like this one is that they will remain significantly lymphopenic.  Even though most do not develop severe infections, some will develop severe viral pneumonitis.  Histoplasmosis and other opportunistic lung infections occur.  Those with plastic bronchitis tend to continue with respiratory issues after the transplant.

Some develop EBV-driven LPD.

Basically, they must be carefully watched.

Terry Harville MD PhD D(ABMLI) D(ABHI)
*Medical Director, Histocompatibility Laboratory
*Medical Director, Immunogenetics and Transplantation Laboratory
*Specialist in Pediatric Allergy, Asthma, Immunology, Rheumatology, Autoimmunity, Hematopoietic Stem cell Transplantation for Immunodeficiencies, and Organ Transplantation Immunology
*Diplomate of the American Board of Medical Laboratory Immunology - specializing in diagnostic evaluations of immunodeficiencies
*Diplomate of the American Board of Histocompatibility and Immunogenetics - specializing in pre- and post-transplantation diagnostic evaluations, disease associations, and platelet transfusion support

Departments of Pathology and Laboratory Services and Pediatrics
University of Arkansas for Medical Sciences
4301 West Markham
Mail Slot #502
Little Rock, AR  72205-7199

Email:....................................................harvilleterryo at uams.edu<mailto:harvilleterryo at uams.edu>

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On Apr 25, 2017, at 10:39 PM, CIS-PIDD <cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>> wrote:

Dear Joe Church,

unfortunately especially in the setting of heart transplantation frequently almost total thymectomy is done. Once the patient is off prednisone, you could check recent thymic emigrant counts and naive/memory T cell count. I personally would start TMP/SMX prophylaxis and keep it if necessary lifelong (as opposed to the guidelines of cardiologists at least in Germany) as we had some bad experience with PCJ infection in this patient group.

Best, Fabian Hauck

Dr. von Hauner Children's Hospital Munich

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Von: cis-pidd at lyris.dundee.net<mailto:cis-pidd at lyris.dundee.net> <cis-pidd at lyris.dundee.net<mailto:cis-pidd at lyris.dundee.net>> im Auftrag von CIS-PIDD <cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>>
Gesendet: Mittwoch, 26. April 2017 02:29
An: CIS-PIDD
Betreff: [cis-pidd] Low T-cells post-Heart Transplant

Colleagues:

I follow a 23yo young man who was born with hypoplastic left heart.  He had the usual surgeries including a Fontan procedure.  He developed very severe protein-losing enteropathy (albumin levels ~2mg/dL).  By 17yo he had pan-hypogammaglobulinemia and T-lymphopenia (CD4 worse than CD8).  Despite the numbers he really did not experience severe, chronic or opportunistic infections.

He received a heart transplant in June 2016.

As expected his serum albumin has gradually improved - latest 3.6.  However, he still has profound pan-lymphocyte deficiency:  CD3+ 46% (97), CD4+ 9% (18), CD8+ 34% (70).

He is still on prednisone (5mg/day), tacrolimus and mycophenolate.

What is the likelihood that he will repopulate his lymphoid populations?

Joe Church
Children's Hospital Los Angeles

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