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Virologic and Immunologic Monitoring of Cytomegalovirus to Guide Preemptive Therapy in Solid‐Organ Transplantation
Author(s) -
Gerna G.,
Lilleri D.,
Chiesa A.,
Zelini P.,
Furione M.,
Comolli G.,
Pellegrini C.,
Sarchi E.,
Migotto C.,
Bonora M. Regazzi,
Meloni F.,
Arbustini E.
Publication year - 2011
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.1600-6143.2011.03636.x
Subject(s) - human cytomegalovirus , medicine , cd8 , immunology , transplantation , immunity , cytomegalovirus , betaherpesvirinae , cellular immunity , flow cytometry , immune system , virology , virus , herpesviridae , viral disease
Control of human cytomegalovirus (HCMV) infection during the posttransplant period was investigated in 134 solid‐organ transplant recipients by monitoring in parallel virologic and immunologic parameters for at least 1 year of follow‐up. Virologic monitoring was achieved by determining HCMV DNAemia with real‐time PCR, using the threshold of 300 000 DNA copies/mL blood as a cutoff for starting preemptive therapy. Immunologic monitoring included measurement of HCMV‐specific CD4+ and CD8+ T cells by cytokine flow cytometry, using HCMV‐infected dendritic cells as a stimulus. HCMV infection was diagnosed in 110 (82%) and required treatment in 49 (36%) patients. At 12 months after transplantation ‘protective’ immunity (≥0.4 CD4+ and CD8+ HCMV‐specific T cells/μL blood) was achieved in 115/129 (89%) patients. During the entire study period, 122 patients reconstituting HCMV‐specific CD4+ and CD8+ T‐cell immunity at 60 days posttransplant onward were able to control HCMV infection, except for one patient who developed HCMV disease because of a rejection episode. Patients reconstituting HCMV‐specific CD8+ only did not control HCMV infection. In conclusion, the presence of both HCMV‐specific CD4+ and CD8+ T cells ≥ 0.4/μL blood appears to be protective against HCMV disease. This result does not apply to patients undergoing antirejection treatment, or reconstituting HCMV‐specific CD8+ T cells only.