Cytomegalovirus T-Cell Responses Predict CMV Infection and Disease After Renal Transplant

摘要

In a prospective study, renal transplant recipients with >20 positive spots in a T-spot assay using a CMV protein were less likely to develop infection or disease than those with <20 spots. Risk assessment for cytomegalovirus (CMV) infection and disease among transplantation recipients is based on donor and recipient serostatus. However, this stratification is not always predictive. Measuring CMV-specific cell-mediated immunity (CMI) could be a more precise measure of the risk for CMV disease in transplant recipients. To assess this further, investigators performed a prospective, multicenter, observational study of 160 renal transplant recipients who were both donor and recipient CMV seropositive. Participants were stratified into high-risk and low-risk CMI groups based on whether they produced <20 or >20 interferon-gamma spots per 3 x 105 peripheral blood mononuclear cells in response to incubation with the CMV immediate-early protein 1 before transplantation, using a commercially available assay (T-SPOT.CMV). Patients were further divided into those receiving 3 months of preemptive antiviral therapy and those with viral replication monitored. Among those in the monitored group, the incidence of CMV infection requiring treatment was significantly higher in the high-risk than the low-risk CMI patients (53.3% vs. 18.5%), as was CMV disease incidence (20.0% vs. 3.7%). This effect was observed when basiliximab, but not rabbit antithymocyte globulin (ATG), was used for induction therapy. With either induction therapy, pretransplant high-risk CMI patients on preemptive antiviral therapy showed significantly higher incidence of late-onset CMV infection compared with low-risk CMI patients (33.3% vs. 4.1%).