Instituto Maimónides de Investigación Biomédica de Córdoba-Reina Sofia University Hospital-University of Cordoba, Cordoba, Spain.
Am J Transplant. 2013 Mar;13(3):738-45. doi: 10.1111/ajt.12049. Epub 2013 Jan 11.
In this prospective study we analyzed pretransplant interferon-γ secretion by cytomegalovirus (CMV)-specific CD8+ T cells to assess its possible utility in determining the risk of CMV replication after solid organ transplantation. A total of 113 lung and kidney transplant patients were enrolled in the study but only 55 were evaluable. All CMV-seronegative recipients were pretransplant "nonreactive" (IFNγ <0.2 IU/mL) (11/11), whereas 30/44 (68.2%) CMV-seropositive (R+) recipients were "reactive" (IFNγ ≥0.2 IU/mL) and 14/44 (31.8%) were "nonreactive". In the R(+) "nonreactive" group, 7/14 (50%) developed posttransplant CMV replication, whereas the virus replicated only in 4/30 (13.3%) of the R(+) "reactive" patients (p = 0.021). According to the best multivariate model, pretransplant "nonreactive" recipients receiving an organ from a CMV-seropositive donor had a 10-fold increased risk of CMV replication compared to pretransplant "reactive" recipients (adjusted OR 10.49, 95% CI 1.88-58.46). This model displayed good discrimination ability (AUC 0.80) and calibration (Hosmer-Lemeshow test, p = 0.92). Negative and positive predictive values were 83.7% and 75%, respectively. The accuracy of the model was 82%. Therefore, assessment of interferon-γ secretion by cytomegalovirus (CMV)-specific CD8+ T cells prior to transplantation is useful in informing the risk of posttransplant CMV replication in solid organ transplant patients.
在这项前瞻性研究中，我们分析了移植前巨细胞病毒（CMV）特异性 CD8+T 细胞产生的干扰素-γ，以评估其在确定实体器官移植后 CMV 复制风险方面的可能效用。共有 113 名肺和肾移植患者入组本研究，但仅有 55 名可评估。所有 CMV 血清阴性的受者在移植前均为“无反应”（IFNγ<0.2IU/mL）（11/11），而 30/44（68.2%）CMV 血清阳性（R+）受者为“有反应”（IFNγ≥0.2IU/mL），14/44（31.8%）为“无反应”。在 R+“无反应”组中，7/14（50%）发生移植后 CMV 复制，而病毒仅在 30/44（13.3%）R+“有反应”患者中复制（p=0.021）。根据最佳多变量模型，与移植前“有反应”的受者相比，接受 CMV 血清阳性供者器官的移植前“无反应”受者发生 CMV 复制的风险增加 10 倍（调整后的 OR 10.49，95%CI 1.88-58.46）。该模型显示出良好的判别能力（AUC 0.80）和校准（Hosmer-Lemeshow 检验，p=0.92）。阴性和阳性预测值分别为 83.7%和 75%。该模型的准确性为 82%。因此，在实体器官移植患者中，移植前评估 CMV 特异性 CD8+T 细胞产生的干扰素-γ有助于预测移植后 CMV 复制的风险。
