Different impact of rATG induction on CMV infection risk in D+R– and R+ KTRs

Abstract Background Rabbit antithymocyte globulin (rATG) induction is associated with profound immunosuppression, leading to a higher risk of cytomegalovirus (CMV) infection compared with anti–interleukin 2 receptor antibody (anti–IL-2RA). However, this risk, depending on the baseline CMV serological recipient/donor status, is still controversial. Methods The CMV DNAemia-free survival between rATG- and anti–IL-2RA–treated patients was analyzed in donor-positive/recipient-negative (D+R−) and recipient-positive (R+) patients in 1 discovery cohort of 559 kidney transplant recipients (KTRs) and 2 independent cohorts (351 and 135 kidney KTRs). The CMV-specific cell-mediated immunity (CMI) at baseline and at different time points after transplantation was assessed using an interferon γ enzyme-linked immunosorbent spot assay. Results rATG increased the risk of CMV DNAemia in R+ but not in D+R− KTRs. In R+ CMI-positive (CMI+) patients, the CMV DNAemia rate was higher in rATG-treated than in anti–IL-2RA–treated patients; no difference was observed among R+ CMI-negative (CMI−) patients. Longitudinal follow-up demonstrated a deeper depletion of preformed CMV CMI in R+ rATG-treated patients. Conclusions D+R− KTRs have the highest risk of CMV DNAemia, but rATG adds no further risk. Among R+ KTRs, we described 3 groups, the least prone being R+CMI+ KTRs without rATG, then R+CMI+ KTRs with rATG, and finally R+CMI− KTRs. CMV serostatus, baseline CMV-specific CMI, and induction therapy may lead to personalized preventive therapy in further studies.

Download Full-text

Post-transplant monitoring of lymphocyte counts predict the occurrence of CMV infection in early phase of kidney transplantation

10.21203/rs.3.rs-45884/v1 ◽

2020 ◽

Author(s):

Sujuan Feng ◽

Jing Yang ◽

Xiaodong Zhang

Keyword(s):

Kidney Transplantation ◽

Peripheral Blood ◽

Operating Characteristic ◽

Roc Curves ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Cmv Infection ◽

Post Transplantation ◽

Cmv Dnaemia

Abstract Objectives The aim of this study was to assess whether monitoring of the number of lymphocytes in peripheral blood was helpful for evaluating the risk of cytomegalovirus (CMV) infection after kidney transplantation. Methods The total numbers of lymphocyte in peripheral blood were measured at baseline and posttransplant months 1, 3 and 6. Risk factors for DNAemia in KTRs were analyzed using univariate logistic regression analyses. Areas under receiver operating characteristic (ROC) curves were applied to assess the accuracy of lymphocyte counts for predicting CMV DNAemia. Results After follow-up 6 months, CMV replication was detected in 12 (31.6%) kidney transplant recipients (KTRs). The total lymphocyte counts were significantly decreased in KTRs with CMV DNAemia in 1, 3 and 6 months. There was a negative correlation between CMV copies and the lymphocyte counts in 1, 3 and 6 months post-transplantation, and the decrease of lymphocyte counts in the 6 months post-transplantation was the risk factor of CMV DNAemia in the KTR. Patients with lymphocyte counts 1.085×109 cells/L had higher cumulative incidence of CMV infection.Conclusions The lymphocyte counts post kidney transplantation may be used as a simple and effective indicator for monitoring the CMV infection status in KTR and for predicting the risk of CMV DNAemia.

Download Full-text

Monitoring of CMV‐specific cell‐mediated immunity with a commercial ELISA‐based interferon‐γ release assay in kidney transplant recipients treated with antithymocyte globulin

American Journal of Transplantation ◽

10.1111/ajt.15793 ◽

2020 ◽

Vol 20 (8) ◽

pp. 2070-2080 ◽

Cited By ~ 3

Author(s):

Mario Fernández‐Ruiz ◽

Isabel Rodríguez‐Goncer ◽

Patricia Parra ◽

Tamara Ruiz‐Merlo ◽

Laura Corbella ◽

...

Keyword(s):

Kidney Transplant ◽

Antithymocyte Globulin ◽

Interferon Γ ◽

Cell Mediated Immunity ◽

Specific Cell ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Release Assay

Download Full-text

Monitoring of Cytomegalovirus (CMV)-Specific Cell-Mediated Immunity in Heart Transplant Recipients: Clinical Utility of the QuantiFERON-CMV Assay for Management of Posttransplant CMV Infection

Journal of Clinical Microbiology ◽

10.1128/jcm.01040-17 ◽

2018 ◽

Vol 56 (4) ◽

Cited By ~ 11

Author(s):

Angela Chiereghin ◽

Luciano Potena ◽

Laura Borgese ◽

Dino Gibertoni ◽

Diego Squarzoni ◽

...

Keyword(s):

Positive Result ◽

Heart Transplant ◽

Clinical Utility ◽

Cell Mediated Immunity ◽

Specific Cell ◽

Antiviral Prophylaxis ◽

Transplant Recipients ◽

Cmv Infection ◽

Heart Transplant Recipients ◽

Cmv Dnaemia

ABSTRACT The clinical utility of the QuantiFERON-CMV (QFN-CMV) assay in heart transplant recipients was assessed. Forty-four cytomegalovirus (CMV)-seropositive patients were enrolled: 17 received antiviral prophylaxis, and 27 were managed preemptively. CMV-DNAemia monitoring was performed by the use of a quantitative real-time PCR assay. The QFN-CMV assay was retrospectively performed on blood samples collected at five posttransplant time points. A higher proportion of patients with an indeterminate QFN-CMV result after the suspension of prophylaxis than of patients who showed a global T-cell responsiveness developed CMV infection ( P = 0.036). Patients who reconstituted a CMV-specific response following the first CMV-DNAemia-positive result (42.9%) showed a median CMV-DNAemia peak 1 log of magnitude lower than that seen with patients with indeterminate results, and all controlled viral replication spontaneously. The 25% of patients with an indeterminate result developed CMV disease. In the preemptive strategy group, no differences in the development of subsequent infection, magnitude of viral load, and viral control were observed on the basis of QFN-CMV measurements performed before and after the first CMV-DNAemia-positive result. Considering both CMV prevention strategies, viral relapse was associated with the failure to reconstitute CMV-specific cell-mediated immunity (CMI) after the resolution of the first episode of CMV infection ( P = 0.032). QFN-CMV measurements can be a useful tool for identifying patients (i) at higher risk of developing infection after discontinuing antiviral prophylaxis, (ii) with late CMV infection who would benefit from appropriate antiviral interventions, and (iii) at higher risk of viral relapses. QFN-CMV measurements taken within 1 month posttransplantation (early period) are not revealing.

Download Full-text

Post-transplant monitoring of lymphocyte counts predict the occurrence of CMV DNAemia in early phase of kidney transplantation

10.21203/rs.3.rs-45884/v2 ◽

2020 ◽

Author(s):

Sujuan Feng ◽

Jing Yang ◽

Xiaodong Zhang

Keyword(s):

Kidney Transplantation ◽

Peripheral Blood ◽

Operating Characteristic ◽

Roc Curves ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Cmv Infection ◽

Post Transplantation ◽

Cmv Dnaemia

Abstract Background The aim of this study was to assess whether monitoring of the number of lymphocytes in peripheral blood was helpful for evaluating the risk of cytomegalovirus (CMV) infection after kidney transplantation. Methods The total numbers of lymphocyte in peripheral blood were measured at baseline and posttransplant months 1, 3 and 6. Risk factors for DNAemia in KTRs were analyzed using univariate logistic regression analyses. Areas under receiver operating characteristic (ROC) curves were applied to assess the accuracy of lymphocyte counts for predicting CMV DNAemia. Results After follow-up 6 months, CMV replication was detected in 12 (31.6%) kidney transplant recipients (KTRs). The total lymphocyte counts were significantly decreased in KTRs with CMV DNAemia in 1, 3 and 6 months. There was a negative correlation between CMV copies and the lymphocyte counts in 1, 3 and 6 months post-transplantation, and the decrease of lymphocyte counts in the 6 months post-transplantation was the risk factor of CMV DNAemia in the KTR. Patients with lymphocyte counts 1.085×109 cells/L had higher cumulative incidence of CMV DNAemia.Conclusions The lymphocyte counts post kidney transplantation may be used as a simple and effective indicator for monitoring the CMV DNAemia status in KTR and for predicting the risk of CMV DNAemia.

Download Full-text