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Preemptive Therapy for Systemic and Pulmonary Human Cytomegalovirus Infection in Lung Transplant Recipients
Author(s) -
Gerna G.,
Lilleri D.,
Rogi V.,
Agozzino M.,
Meloni F.,
Oggionni T.,
Pellegrini C.,
Arbustini E.,
D'Armini A. M.
Publication year - 2009
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2009.02616.x
Subject(s) - medicine , bronchoalveolar lavage , immune system , cd8 , human cytomegalovirus , immunology , lung transplantation , lung , t cell , transplantation , cytomegalovirus , virus , herpesviridae , viral disease
The incidence and treatment of both systemic and pulmonary human cytomegalovirus (HCMV) infection as well as HCMV‐specific T‐cell immune responses were investigated in 57 consecutive lung transplant recipients (LTR) by using as cutoffs for preemptive therapy: 300 000 DNA copies/mL whole blood for systemic infections and 100 000 DNA copies/mL bronchoalveolar lavage fluid for lung infections. Results showed that out of 29/57 LTR (50.9%) needing preemptive antiviral therapy, 15 (51.7%) reached the blood cutoff, 8 (27.6%) the pulmonary cutoff and 6 (20.7%) both the blood and the lung cutoff (3 simultaneously and 3 subsequently). Recovery of HCMV‐specific T‐cell immune responses was achieved much earlier for CD8 + than CD4 + T cells. However, protection from HCMV reactivation was conferred by the presence of both arms of the T‐cell response. In two LTR reaching the pulmonary cutoff and not preemptively treated, a full HCMV‐specific CD4 + and CD8 + T‐cell response was associated with resolution of lung infection. Antirejection steroid therapy suppressed T‐cell immune responses, thus facilitating HCMV reactivation. In conclusion, in LTR, monitoring HCMV infection in both blood and lungs, may improve preemptive therapy efficacy. In addition, monitoring the HCMV‐specific T‐cell immune response appears useful for predicting control of HCMV infection in the posttransplant period.