Assessment of Anti-CMV Immunity by Monitoring Anti-CMV Antibody (CMV-Ab) and CMV-Specific Cytotoxic T Cells (CMV-Tc) in Pediatric Kidney Transplant Recipients (Ped KTx Pts)
1Transplant Immunology Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA
2Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA.
Meeting: 2018 American Transplant Congress
Abstract number: B232
Keywords: Antibodies, Cytomeglovirus, Pediatric, T cell reactivity
Session Information
Session Name: Poster Session B: Kidney: Pediatrics
Session Type: Poster Session
Date: Sunday, June 3, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
Introduction: CMV infection results in significant morbidity in KTx pts, especially CMV sero- ped pts with CMV sero+ donors (D+/R-). CMV infection is controlled primarily by CMV-Ab & Tc. Here we examine the anti-CMV immunity in ped KTx pts by monitoring CMV viremia, CMV-Ab & Tc post-Tx.
Methods: CMV viremia by PCR and CMV-Ab by ELISA were monitored for median 30.7 months (M) post-Tx in 29 ped KTx pts. CMV-Tc by intracellular IFNg flow cytometry was also tested at most recent follow-up. CMV-PCR >5 copies/PCR, CMV-Tc >0.2% and CMV-Ab >0.9U were considered positive. All pts received lymphocyte depletion or anti-IL-2R induction, tacrolimus and MMF w/ or w/o steroids, and valganciclovir prophylaxis for the 1st 6M post-Tx. Treatment for CMV consisted of reduction of MMF and therapeutic dose of valganciclovir.
Results: 23/29 were sero- at Tx and 6 sero+. 8/23 sero- pts (34.8%) developed CMV viremia, while 0/6 sero+ pts did so (p=0.09). Of 23 sero- pts, 8 were D-/R-, with 15 being D+/R-. Only 1/8 D-/R- (12.5%) had viremia, while 7/15 D+/R- (46.7%) developed viremia (p=0.10). Among the 7 D+/R- w/ viremia, 5 were (+) for CMV-Ab & Tc at the last follow-up although it took 6-10M before CMV-Ab became highly (+) after the recurrence of CMV viremia. The remaining 2 D+/R- w/ viremia did not show (+) for CMV-Ab & Tc at 21 and 55 M although CMV-Ab(+) was observed transiently post-viremia. Among the remaining 8 D+/R- w/o detectable viremia, 3 became (+) for CMV-Ab & Tc; 2/3 were non-compliant, and developed de novo DSA and cellular and antibody-mediated rejection. All 6 sero+ pts are currently (+) for CMV-Ab & Tc.
Conclusion: D+/R- ped KTx pts are at highest risk for latent CMV replication. The likelihood of effectively building anti-CMV immunity or developing CMV viremia in this pt cohort is likely dependent on the degree of immunosuppression, as non-compliant pts effectively mounted CMV-Ab & Tc without detectable viremia, while many other pts developed viremia. Seroconversion could be temporary which may associate with CMV viremia recurrence, and seroconversion could occur w/o detectable viremia. Serial testing for CMV-Ab & Tc post-Tx may be helpful in assessing anti-CMV immunity and identify non-compliance in sero- ped pts, especially D+/R-.
CITATION INFORMATION: Shin B., Pizzo H., Jordan S., Lovato D., Petrosyan A., Puliyanda D., Toyoda M. Assessment of Anti-CMV Immunity by Monitoring Anti-CMV Antibody (CMV-Ab) and CMV-Specific Cytotoxic T Cells (CMV-Tc) in Pediatric Kidney Transplant Recipients (Ped KTx Pts) Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Shin B, Pizzo H, Jordan S, Lovato D, Petrosyan A, Puliyanda D, Toyoda M. Assessment of Anti-CMV Immunity by Monitoring Anti-CMV Antibody (CMV-Ab) and CMV-Specific Cytotoxic T Cells (CMV-Tc) in Pediatric Kidney Transplant Recipients (Ped KTx Pts) [abstract]. https://atcmeetingabstracts.com/abstract/assessment-of-anti-cmv-immunity-by-monitoring-anti-cmv-antibody-cmv-ab-and-cmv-specific-cytotoxic-t-cells-cmv-tc-in-pediatric-kidney-transplant-recipients-ped-ktx-pts/. Accessed May 16, 2025.« Back to 2018 American Transplant Congress