Early viral‐specific T‐cell testing predicts late cytomegalovirus reactivation following liver transplantation

Although antiviral prophylaxis is effective in preventing early cytomegalovirus ( CMV ) reactivation following liver transplantation ( OLT ), it predisposes patients to late CMV after prophylaxis has ceased. Quanti FERON – CMV ( QFN ‐ CMV , Qiagen, The Netherlands) measures an individual's viral‐specific immune response. Methods Fifty‐nine OLT recipients were prospectively monitored post‐ OLT in an observational cohort study. QFN ‐ CMV was performed at regular time‐points. An absolute QFN ‐ CMV <0.1  IU / mL was considered non‐reactive. Results 50/59 (84.7%) had a reactive QFN ‐ CMV by M6. 38/59 (64.4%) had antiviral prophylaxis or treatment before M6, with 31/38 (81.6%) developing a reactive QFN ‐ CMV by 6 months. Over 90% already had a reactive result as early as 3 months post transplant, 3 patients (5.08%) developed late CMV between 6‐12 months (median 251 days)—all had a non‐reactive M6 QFN ‐ CMV . And 2/3 experienced CMV disease. Non‐reactive M6 QFN ‐ CMV was significantly associated with late CMV ( OR  = 54.4, PPV  = 0.33, NPV  = 1.00, P  = .003). Conclusion Although only 5% of recipients developed late CMV , 2/3 suffered CMV disease. M6 QFN ‐ CMV has an excellent NPV for late CMV , suggesting patients who exhibit a robust ex vivo immune response at M6 can safely cease CMV monitoring. Furthermore, >90% already express viral‐specific immunity as early as 3 months. Conceivably, antiviral prophylaxis could be discontinued early in these patients.