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Ruiz-Arabi E, Torre-Cisneros J, Aguilera V, Alonso R, Berenguer M, Bestard O, Bodro M, Cantisán S, Carratalà J, Castón JJ, Cordero E, Facundo C, Fariñas MC, Fernández-Alonso M, Fernández-Ruiz M, Fortún J, García-Cosío MD, Herrera S, Iturbe-Fernández D, Len O, López-Medrano F, López-Oliva MO, Los-Arcos I, Marcos MÁ, Martín-Dávila P, Monforte V, Muñoz P, Navarro D, Páez-Vega A, Pérez AB, Redondo N, Rodríguez Álvarez R, Rodríguez-Benot A, Rodríguez-Goncer I, San-Juan R, Sánchez-Céspedes J, Valerio M, Vaquero JM, Viasus D, Vidal E, Aguado JM. Management of cytomegalovirus in adult solid organ transplant patients: GESITRA-IC-SEIMC, CIBERINFEC, and SET recommendations update. Transplant Rev (Orlando) 2024; 38:100875. [PMID: 39168020 DOI: 10.1016/j.trre.2024.100875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 08/02/2024] [Accepted: 08/03/2024] [Indexed: 08/23/2024]
Abstract
Cytomegalovirus (CMV) infection remains a significant challenge in solid organ transplantation (SOT). The last international consensus guidelines on the management of CMV in SOT were published in 2018, highlighting the need for revision to incorporate recent advances, notably in cell-mediated immunity monitoring, which could alter the current standard of care. A working group including members from the Group for the Study of Infection in Transplantation and the Immunocompromised Host (GESITRA-IC) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and the Spanish Society of Transplantation (SET), developed consensus-based recommendations for managing CMV infection in SOT recipients. Recommendations were classified based on evidence strength and quality using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The final recommendations were endorsed through a consensus meeting and approved by the expert panel.
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Affiliation(s)
- Elisa Ruiz-Arabi
- Service of Infectious Diseases, Reina Sofia University Hospital, Maimonides Institute for Biomedical Research (IMIBIC), Cordoba, Spain
| | - Julian Torre-Cisneros
- Service of Infectious Diseases, Reina Sofia University Hospital. Maimonides Institute for Biomedical Research (IMIBIC), University of Cordoba, Córdoba, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
| | - Victoria Aguilera
- Hepatology and Liver Transplantation Unit, Hospital Universitario La Fe-IIS La Fe Valencia, CiberEHD and University of Valencia, Spain
| | - Rodrigo Alonso
- Lung Transplant Unit, Pneumology Service, Instituto de Investigación Hospital 12 de Octubre (imas12), University Hospital 12 de Octubre, Madrid, Spain
| | - Marina Berenguer
- Hepatology and Liver Transplantation Unit, Hospital Universitario La Fe-IIS La Fe Valencia, CiberEHD and University of Valencia, Spain
| | - Oriol Bestard
- Department of Nephrology and Kidney Transplantation, Vall d'Hebron University Hospital-VHIR, Barcelona, Spain
| | - Marta Bodro
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Clinic-IDIBAPS, University of Barcelona, Spain
| | - Sara Cantisán
- Service of Infectious Diseases, Reina Sofia University Hospital. Maimonides Institute for Biomedical Research (IMIBIC), University of Cordoba, Córdoba, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Carratalà
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Bellvitge University Hospital-IDIBELL, University of Barcelona, Spain
| | - Juan José Castón
- Service of Infectious Diseases, Reina Sofia University Hospital. Maimonides Institute for Biomedical Research (IMIBIC), University of Cordoba, Córdoba, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Elisa Cordero
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Unit of Infectious Diseases, Microbiology and Parasitology, Instituto de Biomedicina de Sevilla (IBiS), Virgen del Rocío University Hospital, Junta de Andalucía, CSIC, Universidad de Sevilla, Sevilla, Spain; Departament of Medicine, Faculty of Medicine, Universidad de Sevilla, Spain
| | - Carme Facundo
- Department of Nephrology, Fundacio Puigvert, Institut de Recerca Sant Pau (IR Sant Pau), RICORS 2024 (Kidney Disease), Barcelona, Spain
| | - María Carmen Fariñas
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Universitario Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Mirian Fernández-Alonso
- Microbiology Service, Clínica Universidad de Navarra, IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Mario Fernández-Ruiz
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Unit of Infectious Diseases, University Hospital "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Jesús Fortún
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Service of Infectious Diseases, Ramón y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - Maria Dolores García-Cosío
- Department of Cardiology, University Hospital "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), CIBERCV, Madrid, Spain
| | - Sabina Herrera
- Department of Infectious Diseases, Hospital Clinic-IDIBAPS, University of Barcelona, Spain
| | - David Iturbe-Fernández
- Department of Pneumology, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Oscar Len
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Vall d'Hebron for Solid Organ Transplantation Research Group, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Francisco López-Medrano
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Unit of Infectious Diseases, University Hospital "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | | | - Ibai Los-Arcos
- Department of Infectious Diseases, Vall d'Hebron for Solid Organ Transplantation Research Group, Vall d'Hebron University Hospital, Barcelona, Spain
| | - María Ángeles Marcos
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Department of Clinical Microbiology, Hospital Clinic, University of Barcelona, ISGlobal Barcelona Institute for Global Health, Barcelona, Spain
| | - Pilar Martín-Dávila
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Service of Infectious Diseases, Ramón y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - Víctor Monforte
- Lung Transplant Program, Department of Pulmonology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Patricia Muñoz
- CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitario Gregorio Marañon, Departamento de Medicina, Universidad Complutense, Madrid, Spain
| | - David Navarro
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain. Department of Microbiology School of Medicine, University of Valencia, Spain
| | - Aurora Páez-Vega
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Spain
| | - Ana Belén Pérez
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Microbiology Unit, Hospital Universitario Reina Sofía-Maimonides Institute for Biomedical Research (IMIBIC), Cordoba, Spain
| | - Natalia Redondo
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Unit of Infectious Diseases, University Hospital "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | | | | | - Isabel Rodríguez-Goncer
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Unit of Infectious Diseases, University Hospital "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Rafael San-Juan
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Unit of Infectious Diseases, University Hospital "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Javier Sánchez-Céspedes
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Unit of Infectious Diseases, Microbiology and Parasitology, Instituto de Biomedicina de Sevilla (IBiS), Virgen del Rocío University Hospital, Junta de Andalucía, CSIC, Universidad de Sevilla, Sevilla, Spain
| | - Maricela Valerio
- CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitario Gregorio Marañon, Departamento de Medicina, Universidad Complutense, Madrid, Spain
| | - José Manuel Vaquero
- Unit of Pneumology, Thoracic Surgery, and Lung Transplant, Reina Sofía University Hospital, Cordoba, Spain
| | - Diego Viasus
- Division of Health Sciences, Faculty of Medicine, Universidad del Norte, Hospital Universidad del Norte, Barranquilla, Colombia
| | - Elisa Vidal
- Service of Infectious Diseases, Reina Sofia University Hospital. Maimonides Institute for Biomedical Research (IMIBIC), University of Cordoba, Córdoba, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - José María Aguado
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Unit of Infectious Diseases, University Hospital "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain.
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Obermaier B, Braun C, Hensen L, Ahmad O, Faul C, Lang P, Bethge W, Lengerke C, Vogel W. Adenovirus- and cytomegalovirus-specific adoptive T-cell therapy in the context of hematologic cell transplant or HIV infection - A single-center experience. Transpl Infect Dis 2024; 26:e14296. [PMID: 38830809 DOI: 10.1111/tid.14296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/17/2024] [Accepted: 05/05/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Reactivation of viral infections, in particular cytomegalovirus (CMV) and adenovirus (ADV), cause morbidity and non-relapse-mortality in states of immune deficiency, especially after allogeneic hematopoietic cell transplantation (allo-HCT). Against the background of few available pharmacologic antiviral agents, limited by toxicities and resistance, adoptive transfer of virus-specific T-cells (VST) is a promising therapeutic approach. METHODS We conducted a single-center retrospective analysis of adult patients treated with ADV- or CMV-specific T-cells in 2012-2022. Information was retrieved by review of electronic health records. Primary outcome was a response to VST by decreasing viral load or clinical improvement. Secondary outcomes included overall survival and safety of VST infusion, in particular association with graft-versus-host disease (GVHD). RESULTS Ten patients were included, of whom four were treated for ADV, five for CMV, and one for ADV-CMV-coinfection. Cells were derived from stem cell donors (6/10) or third-party donors (4/10). Response criteria were met by six of 10 patients (4/4 ADV, 2/5 CMV, and 0/1 ADV-CMV). Overall survival was 40%. No infusion related adverse events were documented. Aggravation of GVHD after adoptive immunotherapy was observed in two cases, however in temporal association with a conventional donor lymphocyte infusion and a stem cell boost, respectively. CONCLUSION In this cohort, CMV- and ADV-specific T-cell therapy appear to be safe and effective. We describe the first reported case of virus-specific T-cell therapy for CMV reactivation not associated with transplantation but with advanced HIV infection. This encourages further evaluation of adoptive immunotherapy beyond the context of allo-HCT.
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Affiliation(s)
- Benedikt Obermaier
- Department of Hematology, Oncology, Clinical Immunology, and Rheumatology, Center for Internal Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - Christiane Braun
- Department of Pediatric Hematology and Oncology, University Children's Hospital Tuebingen, Tuebingen, Germany
| | - Luca Hensen
- Department of Hematology, Oncology, Clinical Immunology, and Rheumatology, Center for Internal Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - Osama Ahmad
- Department of Hematology, Oncology, Clinical Immunology, and Rheumatology, Center for Internal Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - Christoph Faul
- Department of Hematology, Oncology, Clinical Immunology, and Rheumatology, Center for Internal Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - Peter Lang
- Department of Pediatric Hematology and Oncology, University Children's Hospital Tuebingen, Tuebingen, Germany
| | - Wolfgang Bethge
- Department of Hematology, Oncology, Clinical Immunology, and Rheumatology, Center for Internal Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - Claudia Lengerke
- Department of Hematology, Oncology, Clinical Immunology, and Rheumatology, Center for Internal Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - Wichard Vogel
- Department of Hematology, Oncology, Clinical Immunology, and Rheumatology, Center for Internal Medicine, University Hospital Tuebingen, Tuebingen, Germany
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