Background: Generally, it is thought that strong immunosuppression causes cytomegalovirus (CMV) infection after kidney transplantation (KT); thus, physicians often reduce the dose of the immunosuppressant at the time of CMV infection. Additionally, high-risk CMV group (i.e. CMV-seronegative recipient (R) from CMV-seropositive donor (D) or the recipients treated with rituximab for preoperative desensitization therapy of ABO-incompatible case) may receive antiviral prophylaxis; however, this treatment strategy is controversial. At our institution, the postoperative immune states are assessed using in vitro mixed lymphocyte reaction (MLR) assay and the doses of immunosuppressant are adjusted accordingly. We do not reduce the immunosuppressant because of CMV infection. Likewise, regardless of the CMV D/R serostatus, we do not prophylactically administer GCV or VGCV. In this study, we evaluated risk factors of CMV infection after KT and the immunological states of patients with CMV infection using an MLR.

Methods: We analyzed 66 patients who underwent KT, and 30 patients of them received preoperative desensitization therapy. To evaluate the immune reactivity of KT recipients, T-cell responses to allostimulation were evaluated using an MLR assay.

Results: Twenty-three of 66 patients had CMV infection. Risk factors of the postoperative CMV infection included recipient CMV-IgG positivity according to multivariable analysis. Whether recipients received desensitization did not affect the presence of postoperative CMV infection. According to the MLR, anti-donor CD4⁺ T-cells showed a hyper-response to the CMV infection, and the anti-donor CD8⁺ T-cell response was maintained.

Conclusions: At the time of CMV infection, the anti-donor T-cell response in the MLR showed a hyper-response, not a hypo-response, and the reduction of immunosuppressant needs to be performed carefully. Additionally, even in the high-risk CMV group, the immune state at the time of the CMV infection was the same as that in the normal condition. We suggest that anti-viral prophylaxis is not needed with appropriate immunosuppression management.

CITATION INFORMATION: Tanaka A, Ide K, Tanaka Y, Ishiyama K, Ohira M, Tahara H, Shimizu S, Kumar D, Ohdan H. Evaluation of Immunological States of Patients with Cytomegalovirus Infection After Kidney Transplantation. Am J Transplant. 2017;17 (suppl 3).

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