Introduction: There is limited data on CMV prevention after face transplantation. We report an individualized approach using prophylaxis followed by surveillance and preemptive therapy guided by viral load and CMV-specific and global CD8+ T cell markers.

Methods: A 31-year-old man received a near-total facial allotransplant for gunshot-related facial deformities. He received Thymoglobulin, then tacrolimus, mycophenolate and prednisone. He was a CMV D+/R-, and received valganciclovir prophylaxis. Serial CD8+ T Cell Immune Competence (TIC) was performed, as measured by interferon-gamma production and CD107a/b degranulation in response to non-specific mitogen or specific MHC Class I alleles/CMV peptides using flow cytometry. CMV replication was measured by CMV PCR.

Results: No CMV-specific CD8 T cell immunity developed during prophylaxis (Table 1). Valganciclovir prophylaxis was discontinued at 7 months, despite lack of CMV-specific immunity, but with sustained normalized global CD8+ T cell function.Asymptomatic CMV replication (CMV 549 IU/ml plasma) occurred 3 months after valganciclovir prophylaxis. At time of viremia, the total CMV-specific CD8+ T cell count was 12 cells/uL. CMV TIC score was 4 indicating effective immunity (Table 1). Valganciclovir treatment resulted in immediate and sustained viral clearance. CMV IgM and IgG were detected. No CMV relapse was detected 17 months after transplant.

Conclusion: Viral and immunologic monitoring allows for an individualized approach to CMV prevention after face transplantation. Even without CMV-specific immunity, a robust global immune function may signify the ability to develop effective immunity during CMV infection.

CITATION INFORMATION: Razonable R., Amer H., Mardini S. An Individualized Strategy Using Virus and Immune-Based Markers to Prevent Cytomegalovirus Disease after Face Transplantation Am J Transplant. 2017;17 (suppl 3).

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