期刊
AMERICAN JOURNAL OF TRANSPLANTATION
卷 9, 期 5, 页码 1142-1150出版社
WILEY-BLACKWELL PUBLISHING, INC
DOI: 10.1111/j.1600-6143.2009.02616.x
关键词
BAL; HCMV; lung transplant; preemptive therapy; T-cell reconstitution; viral load
资金
- Ministero della Salute, Ricerca Corrente [80541, 80425]
- Fondazione Cariplo, Milan [93005]
- Italia-USA Project [98083]
The incidence and treatment of both systemic and pulmonary human cytomegalovirus (HCMV) infection as well as HCMV-specific T-cell immune responses were investigated in 57 consecutive lung transplant recipients (LTR) by using as cutoffs for preemptive therapy: 300 000 DNA copies/mL whole blood for systemic infections and 100 000 DNA copies/mL bronchoalveolar lavage fluid for lung infections. Results showed that out of 29/57 LTR (50.9%) needing preemptive antiviral therapy, 15 (51.7%) reached the blood cutoff, 8 (27.6%) the pulmonary cutoff and 6 (20.7%) both the blood and the lung cutoff (3 simultaneously and 3 subsequently). Recovery of HCMV-specific T-cell immune responses was achieved much earlier for CD8(+) than CD4(+) T cells. However, protection from HCMV reactivation was conferred by the presence of both arms of the T-cell response. In two LTR reaching the pulmonary cutoff and not preemptively treated, a full HCMV-specific CD4(+) and CD8(+) T-cell response was associated with resolution of lung infection. Antirejection steroid therapy suppressed T-cell immune responses, thus facilitating HCMV reactivation. In conclusion, in LTR, monitoring HCMV infection in both blood and lungs, may improve preemptive therapy efficacy. In addition, monitoring the HCMV-specific T-cell immune response appears useful for predicting control of HCMV infection in the posttransplant period.
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