title: Early cytomegalovirus-specific T-cell response and estimated glomerular filtration rate identify patients at high risk of infection after renal transplantation.
abstract: BACKGROUND
  Assessing the risk of cytomegalovirus (CMV) viremia in kidney transplant recipients (KTR) may be helpful to indicate in which patient it is worth starting antiviral treatment during preemptive strategy.
  
  
  METHODS
  In 40 CMV-seropositive KTR preemptively treated with ganciclovir, we used interferon (IFN)-γ ELISpot test to evaluate whether monitoring T cells directed against phosphoprotein (pp) 65 and immediate early (IE)-1 antigens could predict the onset of viremia.
  
  
  RESULTS
  CMV viremia occurred in 24 patients (60%) within 120 days after transplantation. Non-viremic patients had higher anti-pp65, anti-IE-1 T cells, and estimated glomerular filtration rate (eGFR) in the first 90 days after transplantation. At logistic regression, anti-pp65, anti-IE-1 T cells, and eGFR measured at day 30 were significantly associated with CMV infection. Cutoff values of 15 spot-forming cells (SFCs)/200,000 peripheral blood mononuclear cells (PBMCs) for anti-IE, 40 SFCs/200,000 PBMCs for anti-pp65, and 46.6 mL/min/1.73 m(2) for eGFR, respectively, predicted the risk of CMV infection with high sensitivity and specificity (area under the receiver operating characteristic curve >0.75). Using a classification tree model, we identified as high-risk patients those showing anti-pp65 <42 SFCs/200,000 PBMCs and eGFR <62 mL/min/1.73 m(2) , as well as anti-pp65 ≥42 and anti-IE-1 <6.5 SFCs/200,000 PBMCs.
  
  
  CONCLUSIONS
  Monitoring CMV-specific T-cell responses and eGFR in the first month post transplant can identify patients at high risk of CMV infection, for whom preemptive antiviral therapy is recommended.
authors.affiliation: Kidney and Transplantation Research Center, Department of Nephrology, Dialysis and Transplantation, Annunziata Hospital, Cosenza, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Leone
authors.affiliation: Kidney and Transplantation Research Center, Department of Nephrology, Dialysis and Transplantation, Annunziata Hospital, Cosenza, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Gigliotti
authors.affiliation: Microbiology and Virology Laboratory, Molecular Clinic, Annunziata Hospital, Cosenza, Italy.
authors.forename: M V
authors.initials: MV
authors.lastname: Mauro
authors.affiliation: Kidney and Transplantation Research Center, Department of Nephrology, Dialysis and Transplantation, Annunziata Hospital, Cosenza, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Lofaro
authors.affiliation: Microbiology and Virology Laboratory, Molecular Clinic, Annunziata Hospital, Cosenza, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Greco
authors.affiliation: Microbiology and Virology Laboratory, Molecular Clinic, Annunziata Hospital, Cosenza, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Tenuta
authors.affiliation: Microbiology and Virology Laboratory, Molecular Clinic, Annunziata Hospital, Cosenza, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Perugini
authors.affiliation: Kidney and Transplantation Research Center, Department of Nephrology, Dialysis and Transplantation, Annunziata Hospital, Cosenza, Italy.
authors.forename: T
authors.initials: T
authors.lastname: Papalia
authors.affiliation: Kidney and Transplantation Research Center, Department of Nephrology, Dialysis and Transplantation, Annunziata Hospital, Cosenza, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Mollica
authors.affiliation: Kidney and Transplantation Research Center, Department of Nephrology, Dialysis and Transplantation, Annunziata Hospital, Cosenza, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Perri
authors.affiliation: Kidney and Transplantation Research Center, Department of Nephrology, Dialysis and Transplantation, Annunziata Hospital, Cosenza, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Vizza
authors.affiliation: Kidney and Transplantation Research Center, Department of Nephrology, Dialysis and Transplantation, Annunziata Hospital, Cosenza, Italy.
authors.forename: A
authors.initials: A
authors.lastname: La Russa
authors.affiliation: Kidney and Transplantation Research Center, Department of Nephrology, Dialysis and Transplantation, Annunziata Hospital, Cosenza, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Toteda
authors.affiliation: Kidney and Transplantation Research Center, Department of Nephrology, Dialysis and Transplantation, Annunziata Hospital, Cosenza, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Lupinacci
authors.affiliation: Microbiology and Virology Laboratory, Molecular Clinic, Annunziata Hospital, Cosenza, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Giraldi
authors.affiliation: Kidney and Transplantation Research Center, Department of Nephrology, Dialysis and Transplantation, Annunziata Hospital, Cosenza, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Bonofiglio
mesh_terms: D000328:Adult; D003587:Cytomegalovirus / Q000276:immunology*; D003586:Cytomegalovirus Infections / Q000209:etiology*; D004279:DNA, Viral / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000494:pharmacology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013601:T-Lymphocytes / Q000502:physiology*; D014766:Viremia
chemical_list: D004279:DNA, Viral; D007166:Immunosuppressive Agents
keywords: ELISpot; T-cell response; cytomegalovirus infection; glomerular filtration; renal transplantation