title: CMV-specific T-cell immunity, viral load, and clinical outcome in seropositive renal transplant recipients: a pilot study.
abstract: BACKGROUND
  Cytomegalovirus (CMV) infection is still the leading opportunistic infection following solid organ transplantation. The aim of this prospective study of renal transplant recipients was to evaluate the dynamics of CMV-specific T-cells, viral load, and clinical symptoms of CMV infection.
  
  
  METHODS
  Levels of tetramer-selected CD8(+) T-cells (TetraCD8), CMV-specific interferon-gamma producing CD8(+) T-cells (IFNgammaCD8), and CD4(+) T-cells (IFNgammaCD4), measured using major histocompatibility complex-tetramer and cytokine flow cytometry techniques, and CMV DNA were monitored monthly in 17 CMV-seropositive patients up to one yr (median 12 months, range 3-12) after transplantation and correlated to clinical outcome.
  
  
  RESULTS
  CMV DNAemia was detected in 94% of the patients, but only one patient developed CMV disease. CMV DNAemia >1 million copies/mL was seen in asymptomatic patients. CMV-specific T-cells decreased rapidly after transplantation. TetraCD8 and IFNgammaCD8 regenerated within three months, whereas IFNgammaCD4 recovery was impaired up to one yr after transplantation. The proportion of IFNgammaCD4 at two months post-transplantation as compared with baseline, correlated strongly with the magnitude of the CMV DNAemia.
  
  
  CONCLUSIONS
  Monitoring the reduction of IFNgammaCD4 compared with baseline during the first months after transplantation could be considered in predicting risk for high-grade CMV DNAemia and in deciding strategic approaches for pre-emptive and prophylactic therapy.
authors.affiliation: Department of Infectious Diseases, University Hospital, SE 751 85 Uppsala, Sweden. fredrik.sund@akademiska.se
authors.forename: Fredrik
authors.initials: F
authors.lastname: Sund
authors.forename: Anna-Karin
authors.initials: AK
authors.lastname: Lidehäll
authors.forename: Kerstin
authors.initials: K
authors.lastname: Claesson
authors.forename: Aksel
authors.initials: A
authors.lastname: Foss
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Tötterman
authors.forename: Olle
authors.initials: O
authors.lastname: Korsgren
authors.forename: Britt-Marie
authors.initials: BM
authors.lastname: Eriksson
mesh_terms: D000328:Adult; D000368:Aged; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology*; D016022:Case-Control Studies; D003587:Cytomegalovirus / Q000502:physiology*; D003586:Cytomegalovirus Infections / Q000276:immunology*; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D005434:Flow Cytometry; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007111:Immunity, Cellular; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011379:Prognosis; D011446:Prospective Studies; D016036:Seroepidemiologic Studies; D014181:Transplantation Immunology / Q000502:physiology*; D019562:Viral Load
chemical_list: D004279:DNA, Viral