T-Cell Depletion Does Not Increase the Risk of CMV Infection in Donor-Positive, Recipient-Negative Kidney Transplants Due to the Absence of Preformed CMV-Specific Cell-Mediated Immunity

M. Jarque,¹ H. Kaminski,² L. Couzi,² E. Crespo,¹ J. Déchanet-Merville,³ S. Luque,¹ N. Montero,⁴ M. Pascual,⁵ O. Manuel,^5,6 P. Merville,² O. Bestard.^1,4

¹Nephrology Lab, IDIBELL, Barcelona, Spain
²Nephrology Dep, Hôpital Pellegrin, Bordeaux, France
³National Center of Scientific Research, Bordeaux, France
⁴Nephrology Dep, Bellvitge Hospital, Barcelona, Spain
⁵Transplantation Center, Lausanne Hospital, Lausanne, Switzerland
⁶Infectious Diseases Dep, Lausanne Hospital, Lausanne, Switzerland.

Meeting: 2018 American Transplant Congress

Abstract number: 188

Keywords: Cytomeglovirus, Induction therapy, Kidney transplantation

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: 3:30pm-3:42pm

Location: Room 608/609

Kidney transplants (KT) with R-/D+ CMV serostatus receiving T-cell depletion induction are considered as the highest risk population for CMV infection and long-lasting prophylaxis therapy is recommended. However, studies comparing rATG with anti-IL2RA in KT with different CMV-sp serological and Cell-mediated immunity (CMI) has not been investigated yet.

Methods: We evaluated in 1215KT from 3 different centers (BDX, BCN, LSN) the impact of anti-IL2RA or rATG induction on the incidence of infection regarding baseline serostatus. CMV-sp CMI at baseline and at different time points posttransplantation were also compared in KT receiving rATG or anti-IL2RA.

Results: In a first cohort of KT(BDX, n=679), infection risk was significantly higher after rATG than anti-IL2RA induction only among R+KT but not within D+R-(logrank=0.001 vs logrank=0.6, respectively). This data was validated in 2 different cohorts (BCN,n=373,logrank=0.041 and LSN, n=163, logrank<0.001). These results were more evident in KT under preemptive therapy. Analyses on CMV-sp CMI confirmed that only pre-transplant CMI+ rATG-treated patients, but not CMI-, showed significantly higher cumulative incidences of infection than anti-IL2RA-treated KT (logrank, p=0.020) (HR=1.77, 95%CI 1.08-2.89 p=0.023). Post-transplant CMV-sp CMI kinetics revealed that only rATG-treated KT with preformed CMI+ displayed a generalized depletion of CMV-sp CMI after transplantation as compared to anti-IL2RA KT.

Conclusions: rATG induction does only induce an increased risk of infection in KT with preformed CMV-sp CMI. Thus, baseline CMV-sp CMI- KT receiving rATG do not need additional preventive therapy than patients on IL2RA induction therapy.

CITATION INFORMATION: Jarque M., Kaminski H., Couzi L., Crespo E., Déchanet-Merville J., Luque S., Montero N., Pascual M., Manuel O., Merville P., Bestard O. T-Cell Depletion Does Not Increase the Risk of CMV Infection in Donor-Positive, Recipient-Negative Kidney Transplants Due to the Absence of Preformed CMV-Specific Cell-Mediated Immunity Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Jarque M, Kaminski H, Couzi L, Crespo E, Déchanet-Merville J, Luque S, Montero N, Pascual M, Manuel O, Merville P, Bestard O. T-Cell Depletion Does Not Increase the Risk of CMV Infection in Donor-Positive, Recipient-Negative Kidney Transplants Due to the Absence of Preformed CMV-Specific Cell-Mediated Immunity [abstract]. https://atcmeetingabstracts.com/abstract/t-cell-depletion-does-not-increase-the-risk-of-cmv-infection-in-donor-positive-recipient-negative-kidney-transplants-due-to-the-absence-of-preformed-cmv-specific-cell-mediated-immunity/. Accessed November 21, 2024.

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