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Early cytomegalovirus‐specific T‐cell response and estimated glomerular filtration rate identify patients at high risk of infection after renal transplantation
Author(s) -
Leone F.,
Gigliotti P.,
Mauro M.V.,
Lofaro D.,
Greco F.,
Tenuta R.,
Perugini D.,
Papalia T.,
Mollica A.,
Perri A.,
Vizza D.,
La Russa A.,
Toteda G.,
Lupinacci S.,
Giraldi C.,
Bonofiglio R.
Publication year - 2016
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12509
Subject(s) - medicine , viremia , elispot , peripheral blood mononuclear cell , transplantation , renal function , immunology , receiver operating characteristic , cytomegalovirus , ganciclovir , kidney transplantation , t cell , human cytomegalovirus , gastroenterology , immune system , virus , herpesviridae , viral disease , in vitro , biochemistry , chemistry
Background Assessing the risk of cytomegalovirus ( CMV ) viremia in kidney transplant recipients ( KTR ) may be helpful to indicate in which patient it is worth starting antiviral treatment during preemptive strategy. Methods In 40 CMV ‐seropositive KTR preemptively treated with ganciclovir, we used interferon ( IFN )‐γ ELISpot test to evaluate whether monitoring T cells directed against phosphoprotein (pp) 65 and immediate early ( IE )‐1 antigens could predict the onset of viremia. Results CMV viremia occurred in 24 patients (60%) within 120 days after transplantation. Non‐viremic patients had higher anti‐pp65, anti‐ IE ‐1 T cells, and estimated glomerular filtration rate ( eGFR ) in the first 90 days after transplantation. At logistic regression, anti‐pp65, anti‐ IE ‐1 T cells, and eGFR measured at day 30 were significantly associated with CMV infection. Cutoff values of 15 spot‐forming cells ( SFC s)/200,000 peripheral blood mononuclear cells ( PBMC s) for anti‐ IE , 40 SFC s/200,000 PBMC s for anti‐pp65, and 46.6 mL/min/1.73 m 2 for eGFR , respectively, predicted the risk of CMV infection with high sensitivity and specificity (area under the receiver operating characteristic curve >0.75). Using a classification tree model, we identified as high‐risk patients those showing anti‐pp65 <42 SFC s/200,000 PBMC s and eGFR <62 mL/min/1.73 m 2 , as well as anti‐pp65 ≥42 and anti‐ IE ‐1 <6.5 SFC s/200,000 PBMCs. Conclusion Monitoring CMV ‐specific T‐cell responses and eGFR in the first month post transplant can identify patients at high risk of CMV infection, for whom preemptive antiviral therapy is recommended.