Human cytomegalovirus (CMV) infection is still a major complication after kidney transplantation. Although it is well known that cytotoxic CMV-specific CD8+ T cells play a crucial role controlling CMV survival and replication, current pre-transplant immune-monitoring of the risk for CMV infection is only based on donor/recipient (IgG)-serostatus.

Here, we have evaluated the clinical usefulness of monitoring pre-transplant and 6-month CMV-specific CD8+ T-cell responses against two dominant CMV antigens (IE-1 and pp65) and a CMV lysate, in predicting the advent of post-transplant CMV infection or reactivation. For this purpose, we used a highly sensitive IFN-Γ Elispot in a large cohort of kidney transplant recipients (n=137); 39 at high-risk for CMV infection, receiving valgancyclovir prophylaxis and 98 following a preemptive strategy. Incidence of post-transplant 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). Furthermore, only low pre-transplant anti-IE-1-specific T-cell responses independently predicted the risk of both primary and late-onset CMV infection with high sensitivity and specificity (AUC>0,70). Using the most sensitive and specific Elispot cut-off value, a higher than 80% and 90% sensitivity and negative predictive value of the test were obtained, respectively.

Monitoring IE-1-specific T-cell responses before transplantation may be useful for predicting post-transplant risk of CMV infection, thus potentially guiding decision-making regarding CMV preventive treatment.

« Back to 2013 American Transplant Congress