Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada.
Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
J Clin Microbiol. 2022 Aug 17;60(8):e0171621. doi: 10.1128/jcm.01716-21. Epub 2022 May 11.
Cytomegalovirus (CMV) is one of the most important viral complications after solid organ transplantation (SOT). Current preventive and management strategies rely primarily on serologic and viral load testing and remain suboptimal. To address these issues, multiple techniques to measure CMV-specific cell-mediated immunity (CMI) have been developed and evaluated in clinical studies over the past two decades. These assays show significant promise for the personalization of CMV management. For example, CMI assays can be used to help determine the optimal duration of antiviral prophylaxis or whether antiviral therapy is indicated in patients with low levels of CMV reactivation. However, despite numerous studies showing potential utility, these assays are not yet in widespread routine clinical use. Barriers to adoption include variations in test complexity, standardization, and thresholds for positivity and insufficient interventional clinical trials. Here, we provide an updated assessment of commonly available tests and the clinical utility of CMV-specific CMI testing in SOT recipients.
巨细胞病毒（CMV）是实体器官移植（SOT）后最重要的病毒并发症之一。目前的预防和管理策略主要依赖于血清学和病毒载量检测，但仍不尽如人意。为了解决这些问题，过去二十年来，已经开发并评估了多种测量 CMV 特异性细胞介导免疫（CMI）的技术。这些检测方法为 CMV 管理的个体化提供了很大的希望。例如，CMI 检测可用于帮助确定抗病毒预防的最佳持续时间，或者在 CMV 再激活水平较低的患者中是否需要抗病毒治疗。然而，尽管有许多研究表明其具有潜在的用途，但这些检测方法尚未广泛常规应用于临床。采用的障碍包括检测的复杂性、标准化、阳性阈值的差异以及干预性临床试验不足。在这里，我们提供了对常用检测方法的最新评估，以及 CMV 特异性 CMI 检测在 SOT 受者中的临床应用。
