Date: Sunday, June 2, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: While monitoring CMV-specific cell-mediated immunity(CMI) has shown to be effective in predicting the risk of CMV infection, comparisons across different solid organ transplants(SOT) and the optimal time-point for its use has not been evaluated yet. Here we aimed to describe the changes on CMV-specific CMI between pre-transplant and 15 days after transplantation among 3 different SOT(Kidney, Liver and Heart). Additionally, to assess the value and best time-point to assess CMV-specific CMI for predicting subsequent clinically significant CMV infection(CSCI) defined as infection requiring anti-viral treatment. Liver(LT) and Kidney(KT) transplant recipients were used as validation sets, whereas in Heart transplantation, post-transplant anti-viral therapy was determined according to CMV-specific CMI. All SOT received the same immunosuppressive therapy.
*Methods: 98 consecutive CMV-seropositive(R+) SOT were evaluated(49 KT, 31 LT and 18 HT). CMV-specific CMI against both IE-1 and pp65 CMV antigens using the T.SPOT-CMV® was performed at baseline and at 15 days after transplant and were classified as low or high risk (LR, HR). All KT and LT followed a pre-emptive CMV strategy, whereas HT received anti-viral prophylaxis according to the most sensitive/specific CMI cut-off predicting high risk of CMV infection in the KT and LT cohort.
*Results: Among kidney and liver recipients the incidence of CSCI was 16/49(36.7%) and 3/31(9.7%). At baseline, 33/49(67%) and 22/31(71%) KT and LT were classified as LR, whereas this proportion changed at day 15: 19/49(38%) and 14/31(45%). 15-day CMI against IE1 and pp65 predicted CSCI (OR= 29.739; 95%CI 3.718-237.851;p=0.001, OR=3.867; 95%CI 1.320-11.327;p=0.014). Among heart recipients the incidence of CSCI was 2/18(11%). All HT classified as LR at 15-day post-transplantation(5/18) followed a pre-emptive strategy and none of them developed CSCI (NPV 100%).
*Conclusions: Monitoring CMV-specific CMI at 15-day post-transplantation identifies SOT at high risk of CMV infection. Thus, adding the T.SPOT-CMV® in the clinical practice may help establishing guided preventive strategies in the transplant setting.
To cite this abstract in AMA style:Jarque M, Cachero A, Garcia-Romero E, Lladó L, Baliellas C, Diez C, Melilli E, Fabregat J, Gonzalez-Costello J, Bestard O. CMV-Specific Cell-Mediated Immunity Early after Transplantation Discriminates R+ Transplant Patients at Risk of CMV Infection among Different Solid Organ Transplants [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/cmv-specific-cell-mediated-immunity-early-after-transplantation-discriminates-r-transplant-patients-at-risk-of-cmv-infection-among-different-solid-organ-transplants/. Accessed July 16, 2019.
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