CMV-specific T-cell immunity in solid organ transplant recipients at low risk of CMV infection. Chronology and applicability in preemptive therapy - 16/09/17
, Cecilia Martín-Gandul a, Miguel Ángel Gentil b, Gonzalo Suárez-Artacho c, Ernesto Lage d, Magdalena Sánchez a, Elisa Cordero aSummary |
Objectives |
To characterize whether the CMV-specific cellular immune response can be used as a predictor of the control of CMV infection and disease and determine thresholds in solid organ transplant (SOT) recipients seropositive for CMV (R+).
Methods |
The CMV-specific T-cell response was characterized using intracellular cytokine staining and the evolution of clinical and virological parameters were recorded during the first year after transplantation.
Results |
Besides having positive CMV serology, only 28.4% patients had positive immunity (CD8+CD69+IFN-γ+ ≥0.25%) at 2 weeks after transplantation. These patients had less indication of preemptive treatment (p = 0.025) and developed less high grade (≥2000 IU/ml) CMV replication episodes (p = 0.006) than patients with no immunity. Of the 49 patients with a pretransplant sample, only 22.4% had positive immunity, and had a detectable immune response early after transplantation (median of 3.7 weeks). However, only 50% of patients with negative pretransplant immunity acquired a positive immune response and it was significantly later, at a median of 11 weeks (p < 0.001). Patients that developed CMV disease had no CMV-specific immunity.
Conclusions |
Having CMV-specific CD8+IFN-γ+ cells ≥0.25% before transplant; 0.15% at two weeks or 0.25% at four weeks after transplantation, identifies patients that may spontaneously control CMV infection and may require less monitoring.
Le texte complet de cet article est disponible en PDF.Highlights |
• | The CMV-specific T-cell response constitutes the main defense against CMV infection. |
• | A subgroup of transplant patients with no T-cell response is at more risk for CMV infection. |
• | Acquisition of CMV-specific cellular immunity reduced the risk of requiring early treatment and developing high-level viremia in transplant recipients at low risk for CMV infection. |
• | Using CMV serology for stratifying the risk of CMV after transplantation might be insufficient. |
Keywords : Cytomegalovirus, CMV-specific T-cell immune response, Solid organ transplant patients, Immune monitoring, Preemptive therapy
Plan
Vol 75 - N° 4
P. 336-345 - octobre 2017 Retour au numéro
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