Anti-cmv Antibody (cmv-ab) And Cmv-specific Cytotoxic T Cell (cmv-tc) Positivity Are Essential To Control Severe Viremia In Seronegative (sero[-]) Pediatric Kidney Transplant Recipients (ped Ktx Pts).
Cedars-Sinai Medical Center, Los Angeles, CA
Meeting: 2019 American Transplant Congress
Abstract number: C232
Keywords: Antibodies, Cytomeglovirus, Kidney, T cell reactivity
Session Information
Session Name: Poster Session C: Kidney: Pediatrics
Session Type: Poster Session
Date: Monday, June 3, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: CMV infection represents a significant morbidity factor in KTx Pts, especially CMV sero(-) Ped Pts as infections tend to be more severe and recurrent. CMV infections are regulated primarily by CMV-Ab & CMV-Tc. Here, we monitored Ped KTx Pts for CMV viremia, CMV-Ab & CMV-Tc post-Tx to determine best management practices in CMV sero(-) Pts.
*Methods: CMV-PCR monitoring was done for median 12 months (M, 1-100M) post-Tx in 28 Pts. CMV-Ab levels in archived plasma were measured by ELISA. CMV-Tc by intracellular IFNγ flow cytometry was tested 1-2 times in Pts w/o viremia and multiple times in Pts w/ viremia. CMV-PCR >5 copies/PCR, CMV-Ab >1.0U & CMV-Tc >0.2% were considered positive. All pts received induction therapy and were maintained on tacrolimus & MMF w/ or w/o steroids, and valganciclovir prophylaxis. Treatment for CMV infection consisted of therapeutic dose of valganciclovir w/ or w/o IVIG for all Pts.
*Results: Of 28 Pts, 22 (79%) were sero(-) (17 D+) and 6 sero(+) at Tx. None of the 6 sero(+) Pts had viremia. Here, both CMV-Ab (3.1±1.5U) and CMV-Tc (2.0±1.1%) were consistently (+), and the minimum CMV-Ab levels detected were 1.5U. Of 22 sero(-) Pts, 11 (50%, 10 D+) had viremia, with numerous recurrent bouts of viremia. Four of the 11 Pts (36%) showed only temporary CMV-Ab(+) for up to 1.5 years post-1st viremia. CMV-Tc became (+) within 1-2M post-viremia and was usually stable afterward. Seven of the 11 Pts w/ viremia became persistently viremia(-) when CMV-Ab >1.5U and CMV-Tc(+). This was associated with a significant decrease in CMV-PCR levels (273±509 vs. 9±10 copies/PCR, p=0.01). Another sero(-) Pt had persistent viremia w/ 100 copies/PCR w/o development of CMV-Ab, although CMV-Tc was (+). Two other sero(-) Pts had viremia (200 copies/PCR) early post-Tx that quickly resolved. These Pts became CMV-Ab(+) and were free of viremia for 3-5 years despite remaining CMV-Tc(-).
*Conclusions: CMV-Sero(-) Ped KTx Pts are at high risk for severe and recurrence of CMV infection. CMV-Ab(+) and CMV-Tc(+) are essential requirements for persistent freedom from CMV infection. Thus, monitoring for both CMV-Ab & CMV-Tc levels in sero(-) patients is important in designing management strategies for CMV infection in sero(-) patients.
To cite this abstract in AMA style:
Shin B, Pizzo H, Puliyanda D, Petrosyan A, Lovato D, Jordan SC, Toyoda M. Anti-cmv Antibody (cmv-ab) And Cmv-specific Cytotoxic T Cell (cmv-tc) Positivity Are Essential To Control Severe Viremia In Seronegative (sero[-]) Pediatric Kidney Transplant Recipients (ped Ktx Pts). [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/anti-cmv-antibody-cmv-ab-and-cmv-specific-cytotoxic-t-cell-cmv-tc-positivity-are-essential-to-control-severe-viremia-in-seronegative-sero-pediatric-kidney-transplant-recipients-ped-ktx-pts/. Accessed May 13, 2025.« Back to 2019 American Transplant Congress