Cytomegalovirus (CMV) infection is still a major complication after kidney transplantation. Although cytotoxic CMV-specific T cells play a crucial role controlling CMV survival and replication, current pretransplant risk assessment for CMV infection is only based on donor/recipient (IgG)-serostatus. Here, we evaluated the usefulness of monitoring pre- and 6-month CMV-specific T cell responses against two dominant CMV antigens (IE-1 and pp65) and a CMV lysate, using an IFN-γ Elispot, for predicting the advent of CMV infection in two cohorts of 137 kidney transplant recipients either receiving routine prophylaxis (n = 39) or preemptive treatment (n = 98). Incidence of 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). In a ROC curve analysis, low pretransplant anti-IE-1-specific T cell responses predicted the risk of both primary and late-onset CMV infection with high sensitivity and specificity (AUC > 0.70). Furthermore, when using most sensitive and specific Elispot cut-off values, a higher than 80% and 90% sensitivity and negative predictive value was obtained, respectively. Monitoring IE-1-specific T cell responses before transplantation may be useful for predicting posttransplant risk of CMV infection, thus potentially guiding decision-making regarding CMV preventive treatment.

Cytomegalovirus, adult, antigenicity, article, cellular immunity, chronic kidney disease, cohort analysis, controlled study, cytomegalovirus infection, diagnostic test accuracy study, enzyme linked immunospot assay, female, graft recipient, human, human cell, immunosuppressive treatment, kidney transplantation, major clinical study, male, postoperative period, predictive value, preoperative period, priority journal, prophylaxis, receiver operating characteristic, sensitivity and specificity, surgical risk,
American Journal of Transplantation
Erasmus MC: University Medical Center Rotterdam

Bestard, O, Lucia, M, Crespo, E, van Liempt, B, Palacio, D, Melilli, E, … Cruzado, J.M. (2013). Pretransplant immediately early-1-specific T cell responses provide protection for CMV infection after kidney transplantation. American Journal of Transplantation, 13(7), 1793–1805. doi:10.1111/ajt.12256