title: Polyfunctional cytomegalovirus-specific immunity in lung transplant recipients receiving valganciclovir prophylaxis.
abstract: Cytomegalovirus (CMV) is a common opportunistic infection after lung transplant. Despite effective antiviral medications to treat CMV, invasive CMV disease contributes to lung allograft dysfunction and worse survival. Efforts to prevent CMV have led to the use of valganciclovir prophylaxis for increasingly longer periods after transplant. A pivotal concern with long-term antiviral prophylaxis is that it may prevent or delay the development of CMV-specific immunity and increase the subsequent risk of late onset disease. To address this issue, we conducted a pilot study to determine if CMV-specific immunity was detectable in lung transplant recipients at risk for CMV while on antiviral prophylaxis. Utilizing polychromatic flow cytometry panels, CMV-specific immunity was determined by peripheral blood CD4 and CD8 T cell expression of cytokines in response to the HLA restricted CMV peptides pp65 and IE-1. We determined CMV seropositive lung transplant recipients on valganciclovir for a median of 6 months from transplant have a detectable polyfunctional CMV-specific T cell response which is comparable to seropositive recipients not on antiviral medications and to healthy seropositive nontransplant controls. Thus, valganciclovir prophylaxis does not appear to impair the development of CMV-specific immunity in lung transplantation.
authors.affiliation: Department of Medicine Department of Surgery and Immunology Department of Biostatistics & Bioinformatics, Duke University, Durham, NC. laurie.snyder@duke.edu
authors.forename: L D
authors.initials: LD
authors.lastname: Snyder
authors.forename: R
authors.initials: R
authors.lastname: Medinas
authors.forename: C
authors.initials: C
authors.lastname: Chan
authors.forename: S
authors.initials: S
authors.lastname: Sparks
authors.forename: W A
authors.initials: WA
authors.lastname: Davis
authors.forename: S M
authors.initials: SM
authors.lastname: Palmer
authors.forename: K J
authors.initials: KJ
authors.lastname: Weinhold
mesh_terms: D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D003587:Cytomegalovirus / Q000235:genetics / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000517:prevention & control / Q000821:virology*; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D005434:Flow Cytometry; D015774:Ganciclovir / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D007111:Immunity, Cellular; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011183:Postoperative Complications; D012307:Risk Factors; D013601:T-Lymphocytes / Q000276:immunology*; D000077562:Valganciclovir
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D000077562:Valganciclovir; D015774:Ganciclovir