Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, Wisconsin.
Kidney360. 2021 Mar 26;2(5):905-915. doi: 10.34067/KID.0001572021. eCollection 2021 May 27.
Cytomegalovirus (CMV) and BK virus (BKV) are common viral infections after kidney transplant. Their negative effects on patient and graft outcomes have been well described. However, despite improvement in screening and prophylaxis strategies, CMV and BKV continue to negatively affect both short- and long-term graft survival. Adequate cell-mediated immunity is essential for the control and prevention of opportunistic viral infections, such as CMV and BKV. Therefore, immune reconstitution, in particular T cell recovery, is a key factor in antiviral control after kidney transplantation. Cell-based immunotherapy offers an attractive alternative approach to traditional interventions. Adoptive T cell transfer, infusions of allogeneic virus-specific T lymphocytes is capable of restoring virus-specific T cell immunity, and are safe and effective in the treatment of viral infections after hematopoietic stem cell transplantation. In this article, we review the emerging role of virus-specific T cell therapy in the management of CMV and BKV after kidney transplantation. On the basis of the available data, virus-specific T cell therapy may be a promising addition to the antiviral treatment armamentarium after kidney transplantation. Future studies are needed to more clearly define the efficacy and risks of virus-specific T cell therapy in the kidney transplant population.
巨细胞病毒(CMV)和 BK 病毒(BKV)是肾移植后的常见病毒感染。它们对患者和移植物结局的负面影响已有充分描述。然而,尽管筛查和预防策略有所改善,CMV 和 BKV 仍然对短期和长期移植物存活率产生负面影响。适当的细胞介导免疫对于控制和预防机会性病毒感染(如 CMV 和 BKV)至关重要。因此,免疫重建,特别是 T 细胞恢复,是肾移植后抗病毒控制的关键因素。基于细胞的免疫疗法为传统干预提供了一种有吸引力的替代方法。过继性 T 细胞转移,输注同种异体病毒特异性 T 淋巴细胞能够恢复病毒特异性 T 细胞免疫,并且在造血干细胞移植后治疗病毒感染是安全有效的。在本文中,我们回顾了病毒特异性 T 细胞疗法在肾移植后管理 CMV 和 BKV 中的新作用。基于现有数据,病毒特异性 T 细胞疗法可能是肾移植后抗病毒治疗武器库的一个有前途的补充。需要进一步的研究来更清楚地定义病毒特异性 T 细胞疗法在肾移植人群中的疗效和风险。