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T-cell populations in liver and renal transplant recipients with infectious esophagitis
D E Brouillette1, J Alexander, Y K Yoo
1University of Pittsburgh, School of Medicine, Pennsylvania.
Abstract:
Individuals undergoing hepatic and renal transplants are susceptible to infections of the gastrointestinal tract, particularly the esophagus. The most common responsible agents are Candida and herpes simplex virus (HSV) with cytomegalovirus (CMV), Aspergillus, and other agents being regarded as unusual pathogens even in this unique population. Altered T-cell populations have been associated with CMV colitis in healthy homosexuals and in individuals with the acquired immunodeficiency syndrome (AIDS). Similarly, individuals with Epstein-Barr virus infections have altered T-cell populations. Whether these infections alter T-cell populations in infected individuals or the abnormalities in T-cell subpopulations occur first and enhance the likelihood of an infection in susceptible populations is as yet unknown. In this study peripheral blood T-cell populations in individuals before (19 patients) and after (47 patients) liver transplantation and after receiving a renal allograft (21 patients) were compared. Those individual having any symptoms related to esophageal disease underwent upper gastrointestinal endoscopy combined with mucosal biopsies, brushings, and cultures and were subdivided into those with and without infectious esophagitis. CMV esophagitis was found to be associated with an arithmetically decreased T-cell helper/suppressor (H/S) ratio principally due to an increase in the suppressor cell number. Such a reduction in the TH/S ratio and in the number of circulating suppressor cells was not found in esophagitis due to either HSV or Candida and was unrelated to the serum cyclosporine level or prednisone dosage prescribed.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Cytomegalovirus (CMV) esophagitis in transplant patients is linked to a lower T-cell helper/suppressor ratio, primarily due to increased suppressor cells. This specific T-cell change was not observed with other esophagitis causes.
Area of Science:
- Immunology
- Transplantation Medicine
- Gastroenterology
Background:
- Transplant recipients are prone to gastrointestinal infections, especially esophagitis.
- Candida and herpes simplex virus (HSV) are common, while cytomegalovirus (CMV) and Aspergillus are unusual pathogens.
- Altered T-cell populations are linked to CMV infections in other populations.
Purpose of the Study:
- To investigate peripheral blood T-cell populations in liver and renal transplant recipients.
- To compare T-cell profiles in patients with and without infectious esophagitis.
- To determine if CMV esophagitis specifically affects T-cell subpopulations.
Main Methods:
- Peripheral blood T-cell populations were analyzed in 19 pre-transplant, 47 post-liver transplant, and 21 post-renal transplant patients.
- Patients with esophageal symptoms underwent upper endoscopy with biopsies, brushings, and cultures.
- Patients were categorized into those with and without infectious esophagitis.
Main Results:
- CMV esophagitis was associated with a decreased T-cell helper/suppressor (H/S) ratio.
- This reduction was mainly due to an increased number of suppressor cells.
- No such T-cell ratio changes were found in HSV or Candida esophagitis, independent of immunosuppressant drug levels.
Conclusions:
- CMV esophagitis in transplant patients is characterized by a specific decrease in the T-cell H/S ratio.
- This alteration appears distinct from T-cell changes seen in other esophagitis types.
- The findings suggest a potential link between CMV infection and T-cell dysregulation in transplant recipients.