Veit Tobias, Pan Ming, Munker Dieter, Arnold Paola, Dick Andrea, Kunze Susanne, Meiser Bruno, Schneider Christian, Michel Sebastian, Zoller Michael, Böhm Stephan, Walter Julia, Behr Jürgen, Kneidinger Nikolaus, Kauke Teresa
Department of Medicine V, Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany.
Laboratory for Immunogenetics, University of Munich, LMU, Munich, Germany.
Clin Transplant. 2021 Jun;35(6):e14294. doi: 10.1111/ctr.14294. Epub 2021 Apr 3.
Protecting against CMV infection and maintaining CMV in latent state are largely provided by CMV-specific T-cells in lung transplant recipients. The aim of the study was to assess whether a specific T-cell response is associated with the risk for CMV infection in seronegative patients who are at high risk for delayed CMV infection.
All CMV-seronegative recipients (R-) from CMV-seropositive donors (D+) between January 2018 and April 2019 were included and retrospectively screened for CMV infection before and after assessment of CMV-specific cell-mediated immunity.
Thirty-one of the 50 patients (62%) developed early-onset CMV infection. Lower absolute neutrophil counts were significantly associated with early-onset CMV infection. Antiviral prophylaxis was ceased after 137.2 ± 42.8 days. CMV-CMI were measured at a median of 5.5 months after LTx. 19 patients experienced early and late-onset CMV infection after prophylaxis withdrawal within 15 months post transplantation. Positive CMV-CMI was significantly associated with lower risk of late-onset CMV infection after transplantation in logistic and cox-regression analysis (OR=0.05, p = .01; OR=2,369, p = .026).
D+/R- lung transplant recipients are at high risk of developing early and late-onset CMV infection. Measurement of CMV-CMI soon after transplantation might further define the CMV infection prediction risk in LTx recipients being at high risk for CMV viremia.
在肺移植受者中，针对巨细胞病毒（CMV）感染的防护以及将CMV维持在潜伏状态主要由CMV特异性T细胞提供。本研究的目的是评估在发生CMV感染延迟风险较高的血清阴性患者中，特异性T细胞反应是否与CMV感染风险相关。
纳入2018年1月至2019年4月期间所有来自CMV血清阳性供体（D+）的CMV血清阴性受者（R-），并在评估CMV特异性细胞介导免疫之前和之后对CMV感染进行回顾性筛查。
50例患者中有31例（62%）发生早发性CMV感染。较低的绝对中性粒细胞计数与早发性CMV感染显著相关。抗病毒预防在137.2±42.8天后停止。在肺移植术后中位数5.5个月时测量CMV-CMI。19例患者在移植后15个月内停用预防措施后发生早发性和迟发性CMV感染。在逻辑回归和Cox回归分析中，阳性CMV-CMI与移植后迟发性CMV感染风险较低显著相关（OR=0.05，p=0.01；OR=2.369，p=0.026）。
D+/R-肺移植受者发生早发性和迟发性CMV感染的风险较高。移植后不久测量CMV-CMI可能进一步确定CMV病毒血症风险较高的肺移植受者的CMV感染预测风险。
