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CD4 Count in HIV− Brain-Dead Donors: Insight into Donor Risk Assessment for HIV+ Donors

Serrano, Oscar Kenneth MD, MBA; Kerwin, Scott RN; Payne, William D. MD; Pruett, Timothy L. MD

doi: 10.1097/TP.0000000000001506
Original Clinical Science-General

Background: The Human Immunodeficiency Virus (HIV) Organ Policy Equity Act allows for transplantation of organs from HIV-infected individuals (HIV+), provided it is performed under a research protocol. The safety assessment of an organ for transplantation is an essential element of the donation process. The risk for HIV-associated opportunistic infections increases as circulating CD4+ lymphocytes decrease to less than 200 cells/μL; however, the numbers of circulating CD4+ cells in the HIV-negative (HIV−) brain-dead donor (BDD) is not known.

Methods: Circulating T-lymphocyte subset profiles in conventional HIV− BDD were measured in 20 BDD in a clinical laboratory.

Results: The mean age of the BDD cohort was 48.7 years, 95% were white and 45% were women. The average body mass index was 29.2 kg/m2. Cerebrovascular accident (40%) was the most prevalent cause of death. Sixteen (80%) subjects had a CD4 count ≤441 cells/μL (lower limit of normal) and 11 (55%) had a CD4 count less than 200 cells/μL; 11 (55%) subjects had a CD8 count ≤125 cells/μL (lower limit of normal). CD4/CD8 ratio was below normal in 3 patients (normal, 1.4-2.6). No recipient had a recognized donor-associated adverse event.

Conclusions: Absolute numbers of CD4 and CD8 T-lymphocytes are commonly reduced after brain death in HIV− individuals. Thus, CD4 absolute numbers are an inconsistent metric for assessing organ donor risk, irrespective of HIV status.

This study shows that of 20 HIV+ brain-dead donors, 80% had a CD4 count less than normal and no recipient had a recognized donor-associated adverse event suggesting that CD4 absolute numbers should not be used to determine potential HIV+ donor status

1 Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN.

2 Department of Procurement, LifeSource Upper Midwest Organ Procurement Organization, Minneapolis, MN.

Received 24 June 2016. Revision received 13 August 2016.

Accepted 10 September 2016.

The authors declare no funding or conflicts of interest.

O.K.S., W.D.P., and T.L.P. participated in the study conception and design. O.K.S. and S.K. participated in the acquisition of data. O.K.S. and T.L.P. participated in analysis and interpretation of data. O.K.S. and S.K. participated in the drafting of the article. O.K.S., S..K., W.D.P., T.L.P. participated in the critical revision of the article.

Correspondence: Oscar K. Serrano, MD, MBA, Division of Transplantation, Department of Surgery, University of Minnesota, 420 Delaware Street SE, Mayo Mail Code 195, Minneapolis, MN 55455. (serra01@umn.edu).

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