title: The "ABC" of Virus-Specific T Cell Immunity in Solid Organ Transplantation.
abstract: Transplant patients are at increased risk of viral complications due to impaired control of viral replication, resulting from HLA mismatching between graft and host and the immunosuppression needed to avert alloimmune reactions. In the past decade, quantitative viral load measurements have become widely available to identify patients at risk and to inform treatment decisions with respect to immunosuppressive drugs and antiviral therapies. Because viral loads are viewed as the result of viral replication and virus-specific immune control, virus-specific T cell monitoring has been explored to optimize management of adenovirus, BK polyomavirus and cytomegalovirus ("ABC") in transplant patients. Although most studies are descriptive using different technologies, the overall results show that the quantity and quality of virus-specific T cells inversely correlate with viral replication, whereby strong cellular immune responses are associated with containment of viral replication. The key obstacles to the introduction of assays for virus-specific T cells into clinical practice is the definition of reliable cutoffs for clinical decision making, the poor negative predictive value of some assays, and the absence of interventional trials justifying changes of antiviral treatment or immunosuppression. More clinical research is needed using optimized assays and targets before standardization and commutability can be envisaged as achieved for viral load testing.
authors.affiliation: Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Sester
authors.affiliation: Transplantation & Clinical Virology, Department Biomedicine (Haus Petersplatz), University of Basel, Basel, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Leboeuf
authors.affiliation: Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Schmidt
authors.affiliation: Transplantation & Clinical Virology, Department Biomedicine (Haus Petersplatz), University of Basel, Basel, Switzerland.|Division Infection Diagnostics, Department Biomedicine (Haus Petersplatz), University of Basel, Basel, Switzerland.|Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
authors.forename: H H
authors.initials: HH
authors.lastname: Hirsch
mesh_terms: D000818:Animals; D000998:Antiviral Agents / Q000627:therapeutic use; D006801:Humans; D007108:Immune Tolerance / Q000276:immunology*; D016377:Organ Transplantation / Q000009:adverse effects*; D013601:T-Lymphocytes / Q000276:immunology*; D014181:Transplantation Immunology; D014777:Virus Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D014779:Virus Replication / Q000276:immunology*
chemical_list: D000998:Antiviral Agents