title: The lack of cytomegalovirus-specific cellular immune response may contribute to the onset of organ infection and disease in lung transplant recipients.
abstract: Cellular immune response has been demonstrated to play a role in the control of human cytomegalovirus (HCMV) replication in organ transplant recipients. Herein, HCMV-specific T-cell response and association to the onset of organ infection/disease were prospectively evaluated by EliSPOT assay in a population of 46 lung transplant (LT) recipients at 1, 3, 6, 9 and 12 months post-transplantation. According to our centre?s practice, a combined prolonged antiviral prophylaxis (HCMV-IG for 12 months and ganciclovir or valganciclovir for 3 weeks from postoperative day 21) was given to all LT recipients. HCMV-DNA was concomitantly detected on bronchoalveolar lavage (BAL) and whole blood by real-time PCR. Approximately one third of patients resulted HCMV persistently non-responder; the rate of HCMV infection, as evaluated by HCMV-DNA positivity, tended to be higher in non-responders. Mean viral load on BAL was significantly higher in non-responders vs other patients (p &#60; 0.001). Temporal profile of infections appeared related to the HCMV responder status with a shorter time to onset of infection post-transplantation and a longer duration in non-responders. The occurrence of organ disease (i.e. pneumonia) tended to be higher in non-responders, with poor prognosis, as death occurred in one of three non-responder patients that developed HCMV pneumonia. The lack of HCMV-specific cellular response can contribute to the onset of organ infection and disease also in patients in which antiviral prophylaxis was adopted; this could be due to the potential occurrence of incomplete control of replication in lungs or a delayed priming of T-cell reconstitution.
authors.affiliation: San Giovanni Battista Hospital, Turin, Italy. cristina.costa@unito.it
authors.forename: C
authors.initials: C
authors.lastname: Costa
authors.forename: A
authors.initials: A
authors.lastname: Saldan
authors.forename: F
authors.initials: F
authors.lastname: Sinesi
authors.forename: F
authors.initials: F
authors.lastname: Sidoti
authors.forename: C
authors.initials: C
authors.lastname: Balloco
authors.forename: S
authors.initials: S
authors.lastname: Simeone
authors.forename: A
authors.initials: A
authors.lastname: Piceghello
authors.forename: S
authors.initials: S
authors.lastname: Mantovani
authors.forename: A
authors.initials: A
authors.lastname: Di Nauta
authors.forename: P
authors.initials: P
authors.lastname: Solidoro
authors.forename: R
authors.initials: R
authors.lastname: Cavallo
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D003587:Cytomegalovirus / Q000276:immunology*; D003586:Cytomegalovirus Infections / Q000209:etiology*; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006801:Humans; D007111:Immunity, Cellular; D016040:Lung Transplantation / Q000009:adverse effects* / Q000276:immunology; D008297:Male; D008875:Middle Aged
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral