title: Viral load, CMV-specific T-cell immune response and cytomegalovirus disease in solid organ transplant recipients at higher risk for cytomegalovirus infection during preemptive therapy.
abstract: Despite advances in prevention, cytomegalovirus (CMV) recurrence is an important challenge in high-risk organ recipients. The present study prospectively evaluates the impact of CMV-specific T-cell immune response and secondary prophylaxis on the risk of recurrence in a cohort of CMV high-risk organ recipients and whether it is possible to determine a safe standardized viral load value below which CMV disease is unlikely. Thirty-nine recipients were included. Thirty-six had primary infections, and 88.9% recurred. Rate and duration of recurrent CMV infection was similar in patients with and without secondary prophylaxis: 57.9% vs. 53.6%, P = 0.770 and 16 vs. 15 days, P = 0.786, respectively. The only factor independently associated with no episodes of CMV recurrence was the acquisition of CMV-specific T-cell immune response (OR: 0.151, 95% CI: 0.028-0.815; P = 0.028). Cytomegalovirus diseases (N = 5) occurred in patients with CMV viral load above 1500 IU/ml who did not follow the planned monitorization schedule. Our observations suggest that episodes of recurrent CMV infection are common after preemptive therapy despite secondary prophylaxis and that CMV-specific T-cell immune response is associated with a decreased risk of recurrent infections. Preemptive therapy may be safe in patients at high risk for CMV infection with strict close monitoring of the CMV viral load.
authors: Unit of Infectious Disease, Microbiology and Preventive Medicine, Instituto de Biomedicina de Sevilla (IBiS), University Hospital Virgen del Rocío/CSIC/University of Sevilla, Sevilla, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain.
authors: Cecilia
authors: C
authors: Martín-Gandul
authors: Pilar
authors: P
authors: Pérez-Romero
authors: Pilar
authors: P
authors: Blanco-Lobo
authors: Omar J
authors: OJ
authors: Benmarzouk-Hidalgo
authors: Magdalena
authors: M
authors: Sánchez
authors: Miguel A
authors: MA
authors: Gentil
authors: Carmen
authors: C
authors: Bernal
authors: José M
authors: JM
authors: Sobrino
authors: María J
authors: MJ
authors: Rodríguez-Hernández
authors: Elisa
authors: E
authors: Cordero
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D016027:Heart Transplantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007111:Immunity, Cellular / Q000502:physiology*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects* / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D013601:T-Lymphocytes / Q000276:immunology; D014181:Transplantation Immunology; D016896:Treatment Outcome; D019562:Viral Load / Q000276:immunology*; D055815:Young Adult
chemical_list: D000998:Antiviral Agents
keywords: cytomegalovirus infection; cytomegalovirus-specific T-cell immune response; high-risk; preemptive antiviral therapy; solid organ transplantation