title: Pretransplant immediately early-1-specific T cell responses provide protection for CMV infection after kidney transplantation.
abstract: Cytomegalovirus (CMV) infection is still a major complication after kidney transplantation. Although cytotoxic CMV-specific T cells play a crucial role controlling CMV survival and replication, current pretransplant risk assessment for CMV infection is only based on donor/recipient (IgG)-serostatus. Here, we evaluated the usefulness of monitoring pre- and 6-month CMV-specific T cell responses against two dominant CMV antigens (IE-1 and pp65) and a CMV lysate, using an IFN-γ Elispot, for predicting the advent of CMV infection in two cohorts of 137 kidney transplant recipients either receiving routine prophylaxis (n = 39) or preemptive treatment (n = 98). Incidence of CMV antigenemia/disease within the prophylaxis and preemptive group was 28%/20% and 22%/12%, respectively. Patients developing CMV infection showed significantly lower anti-IE-1-specific T cell responses than those that did not in both groups (p < 0.05). In a ROC curve analysis, low pretransplant anti-IE-1-specific T cell responses predicted the risk of both primary and late-onset CMV infection with high sensitivity and specificity (AUC > 0.70). Furthermore, when using most sensitive and specific Elispot cut-off values, a higher than 80% and 90% sensitivity and negative predictive value was obtained, respectively. Monitoring IE-1-specific T cell responses before transplantation may be useful for predicting posttransplant risk of CMV infection, thus potentially guiding decision-making regarding CMV preventive treatment.
authors.affiliation: Department of Nephrology, Renal Transplant Unit, Bellvitge University Hospital, Barcelona, Spain. 35830obm@comb.cat
authors.forename: O
authors.initials: O
authors.lastname: Bestard
authors.forename: M
authors.initials: M
authors.lastname: Lucia
authors.forename: E
authors.initials: E
authors.lastname: Crespo
authors.forename: B
authors.initials: B
authors.lastname: Van Liempt
authors.forename: D
authors.initials: D
authors.lastname: Palacio
authors.forename: E
authors.initials: E
authors.lastname: Melilli
authors.forename: J
authors.initials: J
authors.lastname: Torras
authors.forename: I
authors.initials: I
authors.lastname: Llaudó
authors.forename: G
authors.initials: G
authors.lastname: Cerezo
authors.forename: O
authors.initials: O
authors.lastname: Taco
authors.forename: S
authors.initials: S
authors.lastname: Gil-Vernet
authors.forename: J M
authors.initials: JM
authors.lastname: Grinyó
authors.forename: J M
authors.initials: JM
authors.lastname: Cruzado
mesh_terms: D000956:Antigens, Viral / Q000097:blood / Q000276:immunology; D000998:Antiviral Agents / Q000627:therapeutic use; D003587:Cytomegalovirus / Q000276:immunology*; D003586:Cytomegalovirus Infections / Q000276:immunology* / Q000378:metabolism / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000276:immunology*; D006801:Humans; D017874:Immediate-Early Proteins / Q000276:immunology* / Q000378:metabolism; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D013601:T-Lymphocytes / Q000276:immunology* / Q000378:metabolism / Q000473:pathology
chemical_list: D000956:Antigens, Viral; D000998:Antiviral Agents; D017874:Immediate-Early Proteins