Pre-Transplant Immediately Early-1-Specific T-Cell Responses Provides Protection for CMV Infection after Kidney Transplantation
Renal Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
Experimental Nephrology Department, IDIBELL, Barcelona, Spain
Nefrology Department, Hospital San Vicente de Paul, Bogota, Colombia
Meeting: 2013 American Transplant Congress
Abstract number: A860
Human cytomegalovirus (CMV) infection is still a major complication after kidney transplantation. Although it is well known that cytotoxic CMV-specific CD8+ T cells play a crucial role controlling CMV survival and replication, current pre-transplant immune-monitoring of the risk for CMV infection is only based on donor/recipient (IgG)-serostatus.
Here, we have evaluated the clinical usefulness of monitoring pre-transplant and 6-month CMV-specific CD8+ T-cell responses against two dominant CMV antigens (IE-1 and pp65) and a CMV lysate, in predicting the advent of post-transplant CMV infection or reactivation. For this purpose, we used a highly sensitive IFN-Γ Elispot in a large cohort of kidney transplant recipients (n=137); 39 at high-risk for CMV infection, receiving valgancyclovir prophylaxis and 98 following a preemptive strategy. Incidence of post-transplant CMV antigenemia/disease within the prophylaxis and preemptive group was 28%/20% and 22%/12%, respectively. Patients developing CMV infection showed significantly lower anti-IE-1-specific T-cell responses than those that did not in both groups (p<0,05). Furthermore, only low pre-transplant anti-IE-1-specific T-cell responses independently predicted the risk of both primary and late-onset CMV infection with high sensitivity and specificity (AUC>0,70). Using the most sensitive and specific Elispot cut-off value, a higher than 80% and 90% sensitivity and negative predictive value of the test were obtained, respectively.
Treatment group | Variables | Specificity | Sensitivity | NPV |
Prophylaxis | Pre-TX anti-IE-1 (CMV infection) | 65% | 82,5% | 89,5% |
Preemptive | Pre-TX anti-IE-1 (CMV infection) | 55% | 80% | 95,7% |
Monitoring IE-1-specific T-cell responses before transplantation may be useful for predicting post-transplant risk of CMV infection, thus potentially guiding decision-making regarding CMV preventive treatment.
To cite this abstract in AMA style:
Bestard O, Lucia M, Crespo E, Cruzado J, Palacio D, Melilli E, Torras J, Gil-Vernet S, Grinyó J. Pre-Transplant Immediately Early-1-Specific T-Cell Responses Provides Protection for CMV Infection after Kidney Transplantation [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/pre-transplant-immediately-early-1-specific-t-cell-responses-provides-protection-for-cmv-infection-after-kidney-transplantation/. Accessed October 6, 2024.« Back to 2013 American Transplant Congress