title: Sustained impairment of human cytomegalovirus (HCMV)-specific CD4+ and CD8+ T cell response is responsible for recurrent episodes of disseminated HCMV infection in a D+R- hand transplant recipient.
abstract: Human cytomegalovirus (HCMV) infection is the major viral complication in solid organ transplant recipients. Seronegative recipents (R-) of organs from seropositive donors (D+) appear to be at higher risk of developing symptomatic HCMV infection. To what extent systemic life-threatening complications can be risked for non-life-saving transplant procedures? A case report describing successful treatment of repeated episodes of active HCMV infection in a D+R- hand recipient in the absence of HCMV-specific T-cell immunity is presented. In the attempt to save both the patient and the transplanted hand, a preemptive treatment strategy was adopted with the aim to boost the constitution of the virus-specific T-cell immune response and simultaneously avoid onset of disease. Careful monitoring of HCMV load in blood and HCMV-specific T-cell immunity guided administration of repeated courses of antiviral treatment and avoided emergence of HCMV-related symptoms. Following establishment of HCMV-specific CD4+ and CD8+ T-cell response, preemptive treatment was no longer required due to sustained HCMV disappearance from blood. The patient is now well, and his hand too. In conclusion, evaluation of virus-specific T-cell immunity is of crucial importance in D+R- transplant recipients and careful monitoring of HCMV-specific T cell mediated response should always parallel monitoring of HCMV load in transplant recipients.
authors.affiliation: Servizio di Virologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. f.baldanti@smatteo.pv.it.
authors.forename: Fausto
authors.initials: F
authors.lastname: Baldanti
authors.forename: Giovanna
authors.initials: G
authors.lastname: Lucchini
authors.forename: Daniele
authors.initials: D
authors.lastname: Lilleri
authors.forename: Marco
authors.initials: M
authors.lastname: Lanzetta
references.citation: Blood. 2003 Apr 1;101(7):2686-92
references.pmid: 12411292
references.citation: Hum Immunol. 2004 May;65(5):403-9
references.pmid: 15172438
references.citation: Transplantation. 2008 Aug 27;86(4):487-92
references.pmid: 18724213
references.citation: J Clin Virol. 2008 Mar;41(3):237-41
references.pmid: 18203657
references.citation: J Antimicrob Chemother. 1989 Jun;23 Suppl E:49-60
references.pmid: 2550412
references.citation: Am J Transplant. 2006 Oct;6(10):2356-64
references.pmid: 16889599
references.citation: J Antimicrob Chemother. 2004 Mar;53(3):536-9
references.pmid: 14739146
references.citation: J Hand Surg Br. 2001 Dec;26(6):511-6
references.pmid: 11884098
references.citation: Transplantation. 2003 Mar 15;75(5):724-7
references.pmid: 12640316
references.citation: Eur J Immunol. 2005 Jun;35(6):1795-804
references.pmid: 15902686