Measurement of Humoral Immune Competence and the Risk of Sinopulmonary Infection in a Cohort of Kidney Transplant Recipients

Transplant Proc. 2018 Dec;50(10):3367-3370. doi: 10.1016/j.transproceed.2018.07.017.


Purpose: The aim of this study was to determine if measurement of B cell protective immunity was associated with susceptibility to sinopulmonary infection in kidney transplant recipients.

Methods and materials: A prospective cohort of 168 patients with stable graft function (median 4.1 years) underwent assessment of B-lymphocyte antigen CD19 (CD19+) cell number, immunoglobulin G concentration, and seroresponses to influenza vaccination upon study entry. Patients received a single dose of a trivalent, seasonal influenza vaccine.

Results: After 2 years follow-up, 31 patients (18%) developed sinopulmonary infection. CD19+ cell number was strongly associated with future sinopulmonary infection. A higher proportion of patients with CD19+ cell counts below the fifth percentile for controls developed sinopulmonary infections than those above the fifth percentile, 30% (23 of 77 patients) compared with 9% (7 of 79 patients; P = .001). There was a trend toward a higher proportion of patients with reduced immunoglobulin G concentrations developing infections than in the normal range for controls, 29% (14 of 48 patients) compared with 15% (16 of 108 patients; P = .060). Influenza vaccination seroresponses were poor in patients and controls such that they could not be used to identify a subgroup of patients at high risk for the development of severe pulmonary infection.

Conclusions: Monitoring B-cell numbers represents a simple, inexpensive means of stratifying transplant recipients' risk of sinopulmonary infection.

MeSH terms

  • Adult
  • Cohort Studies
  • Female
  • Humans
  • Influenza A Virus, H1N1 Subtype / immunology
  • Influenza Vaccines
  • Influenza, Human / epidemiology
  • Influenza, Human / immunology*
  • Kidney Transplantation* / adverse effects
  • Male
  • Middle Aged
  • Prospective Studies
  • Risk
  • Seroconversion*
  • Sinusitis / epidemiology
  • Sinusitis / immunology
  • Transplant Recipients*
  • Vaccination


  • Influenza Vaccines