Monitoring cytomegalovirus T-cell immunity in small bowel/multivisceral transplant recipients.
BACKGROUND
Cytomegalovirus (CMV) is a major cause of graft failure and posttransplantation mortality in intestinal/multivisceral transplantation. CMV infection exhibits a wide range of clinical manifestations from asymptomatic infection to severe CMV disease. STUDY'S PURPOSE: The purposes of this study were to assess the utility of measuring CMV-specific cellular immunity in bowel/multivisceral transplant recipients and to provide additional information on the risk of infection and development of CMV disease.


METHODS
We studied 10 bowel/multivisceral transplant recipients to investigate the kinetics of CMV infection using real-time polymerase chain reaction (on blood and biopsy tissue samples) and CMV-specific T-cell reconstitution by Enzyme-linked ImmunoSPOT Assay (ELISPOT) that enumerates Interferon-gamma-secreting CMV-specific T cells upon in vitro stimulation with viral antigens (pp65 and IE-1).


RESULTS
All patients were seropositive for CMV. According to the pattern of T-cell reconstitution occurring either within the first month after transplantation or later, patients were classified as early (n = 7) or late responders (n = 3). Clinically, early responder patients (3/7; 43%) experienced asymptomatic or mild CMV infections, whereas all late responders (3/3; 100%) developed moderate or severe CMV disease. A reduction in mean and peak CMV viral load was observed in early responders, whereas the onset time of infection did not differ significantly between early and late CMV responders.


CONCLUSIONS
A good and early reconstitution of CMV-specific T-cell immune responses after transplantation is a critical determinant in controlling CMV infections. Simultaneous monitoring of CMV infection and CMV-specific T-cell immunity predicts T-cell-mediated control of CMV infection.
Chiereghin
A
A
St. Orsola Malpighi General Hospital, University of Bologna, Bologna, Italy.
Gabrielli
L
L
Zanfi
C
C
Petrisli
E
E
Lauro
A
A
Piccirilli
G
G
Baccolini
F
F
Dazzi
A
A
Cescon
M
M
Morelli
M C
MC
Pinna
A D
AD
Landini
M P
MP
Lazzarotto
T
T
D000328:Adult; D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D003587:Cytomegalovirus / Q000276:immunology*; D003586:Cytomegalovirus Infections / Q000276:immunology*; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use; D006801:Humans; D007111:Immunity, Cellular; D007136:Immunoglobulins / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007421:Intestine, Small / Q000637:transplantation*; D008297:Male; D015166:Monitoring, Immunologic / Q000379:methods; D011183:Postoperative Complications / Q000276:immunology / Q000821:virology; D012189:Retrospective Studies; D013601:T-Lymphocytes / Q000276:immunology*; D016559:Tacrolimus / Q000627:therapeutic use; D014781:Viscera / Q000637:transplantation*
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D000998:Antiviral Agents; D007136:Immunoglobulins; D007166:Immunosuppressive Agents; D000074323:Alemtuzumab; D015774:Ganciclovir; D016559:Tacrolimus