Pretransplant Interferon- Secretion by CMV-Specific CD8+T Cells Informs the Risk of CMV Replication After Transplantation

In this prospective study we analyzed pretransplant interferon- secretion by cytomegalovirus (CMV)-specific CD8+ T cells to assess its possible utility in determining the risk of CMV replication after solid organ transplantation. A total of 113 lung and kidney transplant patients were enrolled in the study but only 55 were evaluable. All CMV-seronegative recipients were pretransplant nonreactive (IFN <0.2 IU/mL) (11/11), whereas 30/44 (68.2%) CMV-seropositive (R+) recipients were reactive (IFN 0.2 IU/mL) and 14/44 (31.8%) were nonreactive. In the R(+) nonreactive group, 7/14 (50%) developed posttransplant CMV replication, whereas the virus replicated only in 4/30 (13.3%) of the R(+) reactive patients (p = 0.021). According to the best multivariate model, pretransplant nonreactive recipients receiving an organ from a CMV-seropositive donor had a 10-fold increased risk of CMV replication compared to pretransplant reactive recipients (adjusted OR 10.49, 95% CI 1.8858.46). This model displayed good discrimination ability (AUC 0.80) and calibration (HosmerLemeshow test, p = 0.92). Negative and positive predictive values were 83.7% and 75%, respectively. The accuracy of the model was 82%. Therefore, assessment of interferon- secretion by cytomegalovirus (CMV)-specific CD8+ T cells prior to transplantation is useful in informing the risk of posttransplant CMV replication in solid organ transplant patients.