Department of Medicine, Division of Nephrology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.
Ren Fail. 2022 Dec;44(1):831-841. doi: 10.1080/0886022X.2022.2072744.
Kidney transplants (KT) from hepatitis C (HCV) viremic donors to HCV negative recipients has shown promising renal outcomes, however, high incidence of cytomegalovirus (CMV) viremia were reported. We performed a prospective cohort study of 52 HCV negative KT recipients from Methodist University Hospital including 41 receiving transplants from HCV aviremic donors and 11 from HCV viremic donors. CMV specific CD4+ and CD8 + T cell immunity was measured by intracellular flow cytometry assay. Primary outcome was the development of positive CMV specific CD4+ and CD8 + T cell immune response in the entire cohort and each subgroup. The association between donor HCV status and CMV specific CD4+ and CD8 + T cell immune response was analyzed by Cox proportional hazard models. Mean recipient age was 48 ± 13 years, with 73% male and 82% African American. Positive CMV specific CD4+ and CD8 + T cell immune response was found in 53% and 47% of the cohort at 1 month, 65% and 70% at 2 months, 80% and 75% at 4 months, 89% and 87% at 6 months, and 94% and 94% at 9 months post-transplant, respectively. There was no significant difference in the incidence of positive CMV specific T cell immune response between recipients of transplants from HCV aviremic donors compared to HCV viremic donors in unadjusted (for CD8+: HR = 1.169, 95%CI: 0.521-2.623; for CD4+: HR = 1.208, 95%CI: 0.543-2.689) and adjusted (for CD8+: HR = 1.072, 95%CI: 0.458-2.507; for CD4+: HR = 1.210, 95%CI: 0.526-2.784) Cox regression analyses. HCV viremia in donors was not associated with impaired development of CMV specific T cell immunity in this cohort.
从丙型肝炎(HCV)病毒血症供体向 HCV 阴性受者进行肾脏移植(KT)已显示出有前景的肾脏结局,但据报道巨细胞病毒(CMV)病毒血症的发生率较高。我们对包括 41 例接受 HCV 非病毒血症供体移植和 11 例接受 HCV 病毒血症供体移植的 52 例 HCV 阴性 KT 受者进行了一项前瞻性队列研究。通过细胞内流式细胞术检测 CMV 特异性 CD4+和 CD8+T 细胞免疫。主要结局是整个队列和每个亚组中 CMV 特异性 CD4+和 CD8+T 细胞免疫应答的发展。通过 Cox 比例风险模型分析供体 HCV 状态与 CMV 特异性 CD4+和 CD8+T 细胞免疫应答的关系。平均受者年龄为 48±13 岁,男性占 73%,非洲裔美国人占 82%。在移植后 1 个月时,队列中有 53%和 47%的患者出现 CMV 特异性 CD4+和 CD8+T 细胞免疫应答,2 个月时分别为 65%和 70%,4 个月时分别为 80%和 75%,6 个月时分别为 89%和 87%,9 个月时分别为 94%和 94%。在未调整(CD8+:HR = 1.169,95%CI:0.521-2.623;CD4+:HR = 1.208,95%CI:0.543-2.689)和调整(CD8+:HR = 1.072,95%CI:0.458-2.507;CD4+:HR = 1.210,95%CI:0.526-2.784)的 Cox 回归分析中,HCV 非病毒血症供体与 CMV 特异性 T 细胞免疫的发育受损无关。