Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: The purpose of this study was to evaluate the predictive potential of a CD4/CD8 flow cytometric cell mediated immunity (CMI) assay for the development of CMV infection after cessation of antiviral therapy.
*Methods: All adult transplant patients at our center with CD4/CD8 assays resulted between 1/1/2018-9/1/2019 were included
*Results: A total of 25 patients underwent CD4/CD8 CMV CMI testing at our institution. The majority were kidney transplant recipients, 76% were high risk serostatus (D+/R-). The majority (92%) had CMI testing sent due to being considered high risk for recurrence based on our clinical risk factor screening protocol, with the presence of at least 1 major, or multiple minor criteria. 60% were undergoing treatment for CMV. 7 patients (28%) had a CMV recurrence after CD4/CD8 testing; 2 (29%) with a positive assay, 4 (57%) with a negative assay and one Not Reported (NR) due to low lymphocyte count. 18 patients did not recur; 14 (78%) had a positive CMV CMI assay. Those with recurrence had an average of 4 risk factors based on screening protocol, those without recurrence had an average of 2 risk factors. The positive predictive value of the assay to predict lack of CMV reactivation after discontinuation of antiviral therapy in the entire population was 87%; negative predictive value was 67%. When patients with antiviral drug resistant CMV were excluded, positive predictive value rose to 93%. When patients only on treatment were analyzed, positive predictive value was 91%.
*Conclusions: Despite the overall high risk of the composite study population, the CD4/CD8 assay had approximately 90% sensitivity in its ability to predict lack of CMV recurrence in the setting of a positive result. The assay had similar predictive potential in the setting of CMV treatment, which is a novel use of this test. The positive predictive value of this assay rose to 93% when patients with previously demonstrated antiviral resistance were excluded. The prediction potential of the assay was less accurate in patients with higher degree of risk based on a clinical risk factor assessment.
To cite this abstract in AMA style:Jorgenson M, Hillis M, Saddler C, Smith J, Mandelbrot D. Clinical Correlation of Results of s CD4/CD8 Cytomegalovirus Cell Mediated Immunity Test with Incidence of Cytomegalovirus Infection [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/clinical-correlation-of-results-of-s-cd4-cd8-cytomegalovirus-cell-mediated-immunity-test-with-incidence-of-cytomegalovirus-infection/. Accessed March 2, 2021.
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