Andreani Marine, Albano Laetitia, Benzaken Sylvia, Cassuto Elisabeth, Jeribi Ahmed, Caramella Anne, Giordanengo Valérie, Bernard Ghislaine, Esnault Vincent, Seitz-Polski Barbara
Service de Néphrologie-Dialyse-Transplantation, CHU de Nice, Université Côte d'Azur, Nice, France.
Laboratoire d'Immunologie, CHU de Nice, Université Côte d'Azur, Nice, France.
Transplant Proc. 2020 Jan-Feb;52(1):204-211. doi: 10.1016/j.transproceed.2019.11.002. Epub 2019 Dec 27.
Cytomegalovirus (CMV) is the most common viral pathogen in kidney transplant recipients (KTRs), and CMV disease impacts patient and graft survivals. CMV-specific CD8 T cell mediated-immunity (CMI) may help to assess the risk of CMV disease and to adapt preventive treatment strategies. High-risk KTRs with CMV seropositive donors/seronegative recipients (D+/R-) were prospectively monitored after CMV prophylaxis discontinuation and during the first year post transplant for CMV viremia (World Health Organization standardization) and CMI (QuantiFERON-CMV). We analyzed the ability of CMI test to predict either subsequent spontaneous viral clearance or CMV disease after prophylaxis discontinuation in patients with asymptomatic viremia. We enrolled 12 consecutive (D+/R-) KTRs. Eleven patients developed a viremia during follow-up, but 7 of them (64%) exhibited a spontaneous viral clearance. At viremia onset, 6 of 11 patients (55%) had a positive CMI test, and all of them (6 of 6, 100%) had subsequent spontaneous viral clearance, compared with only 1 of 5 patients (20%) displaying a nonreactive CMI (P = .02). This latter patient exhibited a positive CMI test 15 days after viremia onset. Four of the 11 patients (36%) developed a CMV disease, and their CMI either remained nonreactive or became positive only after antiviral treatment. We conclude that D+/R- KTRs with asymptomatic viremia after prophylaxis discontinuation may benefit from QuantiFERON-CMV to predict when positive for the spontaneous viral clearance or when persistently negative or the development of a CMV disease.
巨细胞病毒（CMV）是肾移植受者（KTRs）中最常见的病毒病原体，CMV疾病会影响患者和移植物的存活。CMV特异性CD8 T细胞介导的免疫（CMI）可能有助于评估CMV疾病的风险并调整预防治疗策略。对具有CMV血清阳性供体/血清阴性受者（D+/R-）的高风险KTRs在停用CMV预防措施后以及移植后第一年进行前瞻性监测，观察CMV病毒血症（世界卫生组织标准化）和CMI（QuantiFERON-CMV）情况。我们分析了CMI检测在无症状病毒血症患者停用预防措施后预测后续自发病毒清除或CMV疾病的能力。我们纳入了12例连续的（D+/R-）KTRs。11例患者在随访期间出现病毒血症，但其中7例（64%）表现为自发病毒清除。在病毒血症发作时，11例患者中有6例（55%）CMI检测呈阳性，所有这些患者（6例中的6例，100%）随后都实现了自发病毒清除，相比之下，5例CMI检测无反应的患者中只有1例（20%）实现了自发病毒清除（P = 0.02）。后一名患者在病毒血症发作15天后CMI检测呈阳性。11例患者中有4例（36%）发生了CMV疾病，他们的CMI要么一直无反应，要么仅在抗病毒治疗后才转为阳性。我们得出结论，停用预防措施后出现无症状病毒血症的D+/R- KTRs可能受益于QuantiFERON-CMV检测，以预测自发病毒清除呈阳性的时间，或持续阴性或发生CMV疾病的情况。
