title: Virologic and immunologic monitoring of cytomegalovirus to guide preemptive therapy in solid-organ transplantation.
abstract: Control of human cytomegalovirus (HCMV) infection during the posttransplant period was investigated in 134 solid-organ transplant recipients by monitoring in parallel virologic and immunologic parameters for at least 1 year of follow-up. Virologic monitoring was achieved by determining HCMV DNAemia with real-time PCR, using the threshold of 300 000 DNA copies/mL blood as a cutoff for starting preemptive therapy. Immunologic monitoring included measurement of HCMV-specific CD4+ and CD8+ T cells by cytokine flow cytometry, using HCMV-infected dendritic cells as a stimulus. HCMV infection was diagnosed in 110 (82%) and required treatment in 49 (36%) patients. At 12 months after transplantation 'protective' immunity (≥0.4 CD4+ and CD8+ HCMV-specific T cells/μL blood) was achieved in 115/129 (89%) patients. During the entire study period, 122 patients reconstituting HCMV-specific CD4+ and CD8+ T-cell immunity at 60 days posttransplant onward were able to control HCMV infection, except for one patient who developed HCMV disease because of a rejection episode. Patients reconstituting HCMV-specific CD8+ only did not control HCMV infection. In conclusion, the presence of both HCMV-specific CD4+ and CD8+ T cells ≥ 0.4/μL blood appears to be protective against HCMV disease. This result does not apply to patients undergoing antirejection treatment, or reconstituting HCMV-specific CD8+ T cells only.
authors.affiliation: Laboratori Sperimentali di Ricerca, Area Trapiantologica, Fondazione IRCCS Policlinico San Matteo, Pavia 27100, Italy. g.gerna@smatteo.pv.it
authors.forename: G
authors.initials: G
authors.lastname: Gerna
authors.forename: D
authors.initials: D
authors.lastname: Lilleri
authors.forename: A
authors.initials: A
authors.lastname: Chiesa
authors.forename: P
authors.initials: P
authors.lastname: Zelini
authors.forename: M
authors.initials: M
authors.lastname: Furione
authors.forename: G
authors.initials: G
authors.lastname: Comolli
authors.forename: C
authors.initials: C
authors.lastname: Pellegrini
authors.forename: E
authors.initials: E
authors.lastname: Sarchi
authors.forename: C
authors.initials: C
authors.lastname: Migotto
authors.forename: M Regazzi
authors.initials: MR
authors.lastname: Bonora
authors.forename: F
authors.initials: F
authors.lastname: Meloni
authors.forename: E
authors.initials: E
authors.lastname: Arbustini
mesh_terms: D000328:Adult; D000368:Aged; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology* / Q000821:virology; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology* / Q000821:virology; D003587:Cytomegalovirus / Q000235:genetics / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000235:genetics / Q000276:immunology / Q000517:prevention & control; D004279:DNA, Viral / Q000097:blood*; D003713:Dendritic Cells / Q000821:virology; D005260:Female; D005434:Flow Cytometry; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D060888:Real-Time Polymerase Chain Reaction; D019562:Viral Load
chemical_list: D004279:DNA, Viral