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Early viral‐specific T‐cell testing predicts late cytomegalovirus reactivation following liver transplantation
Author(s) -
Sood S.,
Haifer C.,
Yu L.,
Pavlovic J.,
Gow P.J.,
Jones R.M.,
Visvanathan K.,
Angus P.W.,
Testro A.G.
Publication year - 2018
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.12934
Subject(s) - medicine , cytomegalovirus , immunology , transplantation , human cytomegalovirus , virus , viral disease , herpesviridae
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.