Cell-Mediated Immunity to Predict Cytomegalovirus Disease in High-Risk Solid Organ Transplant Recipients |
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Authors: | D. Kumar S. Chernenko G. Moussa I. Cobos O. Manuel J. Preiksaitis S. Venkataraman A. Humar |
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Affiliation: | Transplant Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada;University Health Network, Toronto, Ontario, Canada;Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada;Provincial Public Health Laboratory, Edmonton, Alberta, Canada |
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Abstract: | Late-onset cytomegalovirus (CMV) disease commonly occurs after discontinuation of antiviral prophylaxis. We determined the utility of testing CD8+ T-cell response against CMV as a predictor of late-onset CMV disease after a standard course of antiviral prophylaxis. Transplant patients at high-risk for CMV disease were enrolled. CD8+ T-cell-mediated immunity (CMI) was tested using the QuantiFERON-CMV assay at baseline, 1, 2 and 3 months posttransplant by measurement of interferon-γ response to whole blood stimulation with a 21-peptide pool. The primary outcome was the ability of CMI testing to predict CMV disease in the first 6 months posttransplant. There were 108 evaluable patients (D+/R+ n = 39; D-/R+ n = 34; D+/R- n = 35) of whom 18 (16.7%) developed symptomatic CMV disease. At the end of prophylaxis, CMI was detectable in 38/108 (35.2%) patients (cutoff 0.1 IU/mL interferon-γ). CMV disease occurred in 2/38 (5.3%) patients with a detectable interferon-γ response versus 16/70 (22.9%) patients with a negative response; p = 0.038. In the subgroup of D+/R- patients, CMV disease occurred in 1/10 (10.0%) patients with a detectable interferon-γ response (cutoff 0.1 IU/mL) versus 10/25 (40.0%) patients with a negative CMI, p = 0.12. Monitoring of CMI may be useful for predicting late-onset CMV disease. |
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Keywords: | CD8+ T cells CMV mismatch interferon-γ lung transplant QuantiFERON-CMV assay |
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