Department of Nephrology, Renal Transplant Unit, Bellvitge University Hospital, Barcelona, Spain.
Am J Transplant. 2013 Jul;13(7):1793-805. doi: 10.1111/ajt.12256. Epub 2013 May 24.
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.
巨细胞病毒（CMV）感染仍然是肾移植后的主要并发症。尽管细胞毒性 CMV 特异性 T 细胞在控制 CMV 存活和复制方面起着至关重要的作用，但目前 CMV 感染的移植前风险评估仅基于供体/受者（IgG）-血清状态。在这里，我们使用 IFN-γ Elispot 评估了监测针对两种主要 CMV 抗原（IE-1 和 pp65）和 CMV 裂解物的 CMV 特异性 T 细胞反应在前和 6 个月的用途，以预测两个队列的 137 名接受常规预防（n = 39）或抢先治疗（n = 98）的肾移植受者发生 CMV 感染的情况。预防组和抢先治疗组的 CMV 抗原血症/疾病发生率分别为 28%/20%和 22%/12%。在两组中，发生 CMV 感染的患者的抗 IE-1 特异性 T 细胞反应明显低于未感染的患者（p <0.05）。在 ROC 曲线分析中，低移植前抗 IE-1 特异性 T 细胞反应可预测原发性和迟发性 CMV 感染的风险，具有高敏感性和特异性（AUC > 0.70）。此外，当使用最敏感和特异性的 Elispot 截止值时，获得了分别高于 80%和 90%的敏感性和阴性预测值。在移植前监测 IE-1 特异性 T 细胞反应可能有助于预测 CMV 感染的移植后风险，从而有可能指导 CMV 预防治疗的决策。
