Background: We do not currently have sufficient predictive tools to determine risk of CMV infection after organ transplantation. Recent data suggest that assays of the CMV-specific cellular immunity appear promising in predicting the risk of CMV infection, allowing for personalized prevention. Such assays may optimize our ability to prevent CMV and enhance transplant outcomes, while limiting infection, cost, toxicity, and phlebotomy. Whether such lymphocyte-based assays are useful in the immediate post-transplant phase after the administration of anti-lymphocyte therapy has not yet been studied. The primary objective was to establish the timeframe of the return of CMV cell mediated immunity after kidney transplant in patients given thymoglobulin, and to determine whether such lymphocyte based assays would yield clinically useful information soon after transplant.

Methods: 36 CMV seropositive adult kidney transplant recipients who had received thymoglobulin at a single center underwent T-SPOT.CMV testing once within 6 months of transplant. Normalization dilution resulted in 250,000 cells/well plated.

Results: Among study subjects, the average age was 53 ± 13 years and 47% were female. The average creatinine at the time of the assay was 1.3 mg/dL ± 0.5, average WBC was 6.5 x 10⁹ per liter ± 2.0, and lymphocytes 11.5% ±6.6 All but 3 of 36 had detectable CMV immune responses; those 3 were among 8 within the first 3 weeks after transplant. By week 9 after transplant, T-SPOT.CMV results were similar to normal controls.

Conclusion: CMV-specific cellular immunity returned rapidly within the first few months after transplant in patients given thymoglobulin, suggesting that assays of cellular immunity, specifically T-SPOT.CMV, may be useful shortly after organ transplant even in the setting of lymphocyte depleting agents.

CITATION INFORMATION: Kotton C. Assessing Return of CMV Specific Cellular Immunity Using the T-SPOT.CMV Soon After Kidney Transplant with Thymoglobulin. Am J Transplant. 2016;16 (suppl 3).

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