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Clin Infect Dis. 2014 Dec 1;59(11):1537-45. doi: 10.1093/cid/ciu589. Epub 2014 Jul 21.

Preformed frequencies of cytomegalovirus (CMV)-specific memory T and B cells identify protected CMV-sensitized individuals among seronegative kidney transplant recipients.

Author information

1
Experimental Nephrology Laboratory, Bellvitge Biomedical Research Institute.
2
Renal Transplant Unit, Nephrology Department.
3
Experimental Nephrology Laboratory, Bellvitge Biomedical Research Institute Renal Transplant Unit, Nephrology Department.
4
Microbiology Department.
5
Infectious Disease Department, Bellvitge University Hospital, Barcelona, Spain.

Abstract

BACKGROUND:

Cytomegalovirus (CMV) infection remains a major complication after kidney transplantation. Baseline CMV risk is typically determined by the serological presence of preformed CMV-specific immunoglobulin (Ig) G antibodies, even though T-cell responses to major viral antigens are crucial when controlling viral replication. Some IgG-seronegative patients who receive an IgG-seropositive allograft do not develop CMV infection despite not receiving prophylaxis. We hypothesized that a more precise evaluation of pretransplant CMV-specific immune-sensitization using the B and T-cell enzyme-linked immunospot assays may identify CMV-sensitized individuals more accurately, regardless of serological evidence of CMV-specific IgG titers.

METHODS:

We compared the presence of preformed CMV-specific memory B and T cells in kidney transplant recipients between 43 CMV IgG-seronegative (sR(-)) and 86 CMV IgG-seropositive (sR(+)) patients. Clinical outcome was evaluated in both groups.

RESULTS:

All sR(+) patients showed a wide range of CMV-specific memory T- and B-cell responses. High memory T- and B-cell frequencies were also clearly detected in 30% of sR(-) patients, and those with high CMV-specific T-cell frequencies had a significantly lower incidence of late CMV infection after prophylactic therapy. Receiver operating characteristic curve analysis for predicting CMV viremia and disease showed a high area under the receiver operating characteristic curve (>0.8), which translated into a high sensitivity and negative predictive value of the test.

CONCLUSIONS:

Assessment of CMV-specific memory T- and B-cell responses before kidney transplantation among sR(-) recipients may help identify immunized individuals more precisely, being ultimately at lower risk for CMV infection.

KEYWORDS:

CMV infection; T- and B-cell ELISPOT assay; adaptive immunity; kidney transplantation

PMID:
25048845
PMCID:
PMC4650765
DOI:
10.1093/cid/ciu589
[Indexed for MEDLINE]
Free PMC Article

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