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CMV-Specific Cell-Mediated Immunity after Valgancyclovir Prophylaxis Predicts Late Onset CMV Infection in Kidney Transplant Patients

M. Jarque,1 E. Crespo,1 E. Melilli,2 A. Manonelles,2 N. Montero,2 S. Luque,1 J. Cruzado,1,2 J. Grinyo,1,2 O. Bestard.1,2

1Experimental Nephrology Laboratory, IDIBELL, Barcelona, Spain
2Nephrology Department, Bellvitge University Hospital, Barcelona, Spain.

Meeting: 2018 American Transplant Congress

Abstract number: 184

Keywords: Cytomeglovirus, Kidney transplantation, Monitoring, T cell reactivity

Session Information

Session Name: Concurrent Session: CMV: Bench to Bedside

Session Type: Concurrent Session

Date: Monday, June 4, 2018

Session Time: 2:30pm-4:00pm

 Presentation Time: 2:42pm-2:54pm

Location: Room 608/609

Background: There is currently no means to predict late-onset CMV infection after a long course of post-transplant Valgancyclovir prophylaxis therapy and its development still negatively impacts on graft and patient outcomes. However, CMV-sp CMI has shown promise to identify at-risk patients of developing CMV infection after transplantation.

Methods: 89 consecutive R+ KT patients were evaluated at the time of Valgancyclovir prophylaxis withdrawal for their CMV-sp CMI against main antigens (IE-1, pp65) using the T-SPOT.CMV®, to predict late onset infection.

Results: 49/89 (44.9%) received anti-ILR2A and 40/89 (55.1%) rATG induction therapy. All patients received a TAC/MMF-based immunosuppression. 10/89 (11.2%) patients developed late onset CMV infection. When all patients were pooled together, CMV-sp CMI to IE-1 and pp65 were significantly lower in patients displaying CMV infection than those that did not (48.3±73.7 vs 195.3±224.8, p<0.001 for IE-1 and 164.7±192.3 vs 338.4±263.3 IFN-γ spots, p=0.047 for pp65). CMV-sp CMI was significantly lower in patients developing CMV infection when stratifying according to the type of induction therapy either anti-IL2RA or rATG. A ROC curve analysis was performed in order to stablish the most sensitive and specific CMI cut-off to classify patients into High(HR), Intermediate(IR) and low(LR) risk. Cumulative incidence of CMV infection among HR was significantly higher than IR and LR (Log-rank<0.001) (HR 9.09, 95%CI 2.34-35.19, p=0.001). Sensitivity, specificity, PPV and NPV of CMV-sp CMI predicting CMV infection was 70%, 83.5%, 35%, 95.7%, respectively.

Conclusions: Monitoring CMV-sp CMI after valgancyclovir prophylaxis withdrawal is able to accurately rule out KT at high risk of late-onset CMV infection, regardless other traditional clinical variables.

CITATION INFORMATION: Jarque M., Crespo E., Melilli E., Manonelles A., Montero N., Luque S., Cruzado J., Grinyo J., Bestard O. CMV-Specific Cell-Mediated Immunity after Valgancyclovir Prophylaxis Predicts Late Onset CMV Infection in Kidney Transplant Patients Am J Transplant. 2017;17 (suppl 3).

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To cite this abstract in AMA style:

Jarque M, Crespo E, Melilli E, Manonelles A, Montero N, Luque S, Cruzado J, Grinyo J, Bestard O. CMV-Specific Cell-Mediated Immunity after Valgancyclovir Prophylaxis Predicts Late Onset CMV Infection in Kidney Transplant Patients [abstract]. https://atcmeetingabstracts.com/abstract/cmv-specific-cell-mediated-immunity-after-valgancyclovir-prophylaxis-predicts-late-onset-cmv-infection-in-kidney-transplant-patients/. Accessed June 1, 2025.

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