期刊
AMERICAN JOURNAL OF TRANSPLANTATION
卷 13, 期 7, 页码 1793-1805出版社
WILEY-BLACKWELL
DOI: 10.1111/ajt.12256
关键词
Cytomegalovirus infection; Elispot; kidney transplantation; T cell response
资金
- Fundacioen Mutua Madrilena
- Instituto de Investigacioen Carlos III [PI10/01786]
- Red de Investigacioen Renal (REDinREN) [ISCIII 06/0016]
- European Commission within the RISET consortium [EU 512090]
Cytomegalovirus (CMV) infection is still a major complication after kidney transplantation. Although cytotoxic CMV-specific T cells play a crucial role controlling CMV survival and replication, current pretransplant risk assessment for CMV infection is only based on donor/recipient (IgG)-serostatus. Here, we evaluated the usefulness of monitoring pre- and 6-month CMV-specific T cell responses against two dominant CMV antigens (IE-1 and pp65) and a CMV lysate, using an IFN- Elispot, for predicting the advent of CMV infection in two cohorts of 137 kidney transplant recipients either receiving routine prophylaxis (n=39) or preemptive treatment (n=98). Incidence of CMV antigenemia/disease within the prophylaxis and preemptive group was 28%/20% and 22%/12%, respectively. Patients developing CMV infection showed significantly lower anti-IE-1-specific T cell responses than those that did not in both groups (p<0.05). In a ROC curve analysis, low pretransplant anti-IE-1-specific T cell responses predicted the risk of both primary and late-onset CMV infection with high sensitivity and specificity (AUC>0.70). Furthermore, when using most sensitive and specific Elispot cut-off values, a higher than 80% and 90% sensitivity and negative predictive value was obtained, respectively. Monitoring IE-1-specific T cell responses before transplantation may be useful for predicting posttransplant risk of CMV infection, thus potentially guiding decision-making regarding CMV preventive treatment.
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