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Razonable RR. Pathogen-specific cell-mediated immunity to guide the management of cytomegalovirus in solid organ transplantation: state of the art clinical review. Expert Rev Clin Immunol 2024:1-14. [PMID: 39039915 DOI: 10.1080/1744666x.2024.2384060] [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: 04/02/2024] [Accepted: 07/21/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION Cytomegalovirus (CMV) is a common opportunistic infection after solid organ transplantation, with significant impact on morbidity and long-term survival. Despite advances in diagnostics and therapeutics, the management of CMV remains very challenging. AREAS COVERED This article reviews emerging data on the clinical utility of laboratory assays that quantify cell-mediated immune responses to CMV. Observational studies have consistently demonstrated that a deficiency in pathogen-specific cell-mediated immunity is correlated with a heightened risk of primary, reactivation or recurrent CMV after transplantation. A limited number of interventional studies have recently investigated cell-mediated immune assays in guiding the prevention and treatment of CMV infection after solid organ transplantation. EXPERT OPINION The pathogenesis and outcome of CMV after solid organ transplantion reflect the interplay between viral replication and CMV-specific immune reconstitution. Research in CMV-specific cell-mediated immunity paved way for the development of several laboratory assays that may assist clinicians in predicting the risk of CMV after transplantation, individualize the approach to CMV disease prevention, guide the need and duration of treatment of CMV infection, and predict the risk of relapse after treatment. More interventional studies are needed to further solidify the role of cell-mediated immune assays in various clinical situations after transplantation.
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Affiliation(s)
- Raymund R Razonable
- Division of Public Health, Infectious Diseases and Occupational Medicine, and the William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA
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2
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Sandikçi B, Ulukuş MY, Ergün MA, Tanriöver B. Cytomegalovirus Matching in Deceased Donor Kidney Allocation: Results From a U.S. National Simulation Model. Transplant Direct 2024; 10:e1622. [PMID: 38769987 PMCID: PMC11104729 DOI: 10.1097/txd.0000000000001622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/22/2024] [Accepted: 02/29/2024] [Indexed: 05/22/2024] Open
Abstract
Background Cytomegalovirus (CMV) infects >60% of adults and can pose an independent risk factor for allograft loss and mortality in solid organ transplant recipients. The purpose of this study is to evaluate the impact of a nationwide implementation of CMV seromatching (donor/recipient: D-/R- and D+/R+) in the U.S. deceased donor kidney allocation system (KAS). Methods Adult candidates on the U.S. kidney-only transplant waiting list and deceased donor kidneys offered to the U.S. transplant centers were considered. A discrete-event simulation model, simulating the pre-COVID-19 period from January 1, 2015, to January 1, 2018, was used to compare the performances of currently employed KAS-250 policy (without CMV matching) to various simulated CMV matching policies parameterized by calculated panel reactive antibody exception threshold. Outcomes included CMV serodistribution, waiting time, access to transplantation among various groups, transplant rate, graft survival, kidney discard rate, and antigen-mismatch distribution, stratified by CMV serostatus. Results CMV matching policy with a calculated panel reactive antibody exception threshold of 50% (namely, the CMV">50%" policy) strikes a better balance between benefits and drawbacks of CMV matching. Compared with KAS-250, CMV">50%" reduced CMV high-risk (D+/R-) transplants (6.1% versus 18.1%) and increased CMV low-risk (D-/R-) transplants (27.2% versus 13.1%); increased transplant rate for CMV R- patients (11.54 versus 12.57) but decreased for R+ patients (10.68 versus 10.48), yielding an increase in aggregate (11.09 versus 10.94); and reduced mean time to transplantation (by 6 wk); and reduced kidney discard rate (25.7% versus 26.2%). Conclusions Our findings underscore the feasibility and potential advantages of a nationwide CMV seromatching policy in kidney transplantation.
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Affiliation(s)
- Burhaneddin Sandikçi
- Department of Industrial Engineering, Istanbul Technical University, Istanbul, Türkiye
| | - M Yasin Ulukuş
- Department of Industrial Engineering, Istanbul Technical University, Istanbul, Türkiye
| | - Mehmet Ali Ergün
- Department of Industrial Engineering, Istanbul Technical University, Istanbul, Türkiye
| | - Bekir Tanriöver
- Division of Nephrology, College of Medicine, University of Arizona, Tucson, AZ
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3
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Higdon LE, Ahmad AA, Schaffert S, Margulies KB, Maltzman JS. CMV-Responsive CD4 T Cells Have a Stable Cytotoxic Phenotype Over the First Year Post-Transplant in Patients Without Evidence of CMV Viremia. Front Immunol 2022; 13:904705. [PMID: 35837398 PMCID: PMC9275561 DOI: 10.3389/fimmu.2022.904705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022] Open
Abstract
Cytomegalovirus (CMV) infection is a known cause of morbidity and mortality in solid organ transplant recipients. While primary infection is controlled by a healthy immune system, CMV is never eradicated due to viral latency and periodic reactivation. Transplantation and associated therapies hinder immune surveillance of CMV. CD4 T cells are an important part of control of CMV reactivation. We therefore investigated how CMV impacts differentiation, functionality, and expansion of protective CD4 T cells from recipients of heart or kidney transplant in the first year post-transplant without evidence of CMV viremia. We analyzed longitudinal peripheral blood samples by flow cytometry and targeted single cell RNA sequencing coupled to T cell receptor (TCR) sequencing. At the time of transplant, CD4 T cells from CMV seropositive transplant recipients had a higher degree of immune aging than the seronegative recipients. The phenotype of CD4 T cells was stable over time. CMV-responsive CD4 T cells in our transplant cohort included a large proportion with cytotoxic potential. We used sequence analysis of TCRαβ to identify clonal expansion and found that clonally expanded CMV-responsive CD4 T cells were of a predominantly aged cytotoxic phenotype. Overall, our analyses suggest that the CD4 response to CMV is dominated by cytotoxicity and not impacted by transplantation in the first year. Our findings indicate that CMV-responsive CD4 T cells are homeostatically stable in the first year after transplantation and identify subpopulations relevant to study the role of this CD4 T cell population in post-transplant health.
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Affiliation(s)
- Lauren E. Higdon
- Department of Medicine, Nephrology, Stanford University, Palo Alto, CA, United States
- *Correspondence: Lauren E. Higdon, ; Jonathan S. Maltzman,
| | - Ayah A. Ahmad
- Macaulay Honors College, Hunter College, The City University of New York, New York, NY, United States
| | - Steven Schaffert
- Institute for Immunity, Transplantation and Infection, Stanford University, Stanford, CA, United States
- Department of Medicine/Biomedical Informatics, Stanford University, Stanford, CA, United States
| | - Kenneth B. Margulies
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jonathan S. Maltzman
- Department of Medicine, Nephrology, Stanford University, Palo Alto, CA, United States
- Geriatric Research Education and Clinical Center, Veteran's Affairs Palo Alto Health Care System, Palo Alto, CA, United States
- *Correspondence: Lauren E. Higdon, ; Jonathan S. Maltzman,
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Pizzo H, Shin B, Garrison J, Huang E, Malekzadeh M, Jordan SC, Puliyanda D, Toyoda M. Development of CMV-specific cytotoxic T cells (CMV-Tc) in pediatric renal transplant recipients with CMV viremia. Pediatr Transplant 2021; 25:e14119. [PMID: 34390094 DOI: 10.1111/petr.14119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/09/2021] [Accepted: 08/02/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Viral infections are controlled primarily by viral-specific T cells, raising concern for adequate T-cell response to clear CMV infection in transplant recipients receiving lymphocyte-depleting agents (LDA). We examined the rates of CMV viremia and clearance, seroconversion, and CMV-specific CD8+ T cell (CMV-Tc) activity with class of induction agent received. METHODS Retrospective review of 45 pediatric renal transplant recipients who received induction with LDA (n = 31) or non-LDA (NLDA; n = 14) received valganciclovir prophylaxis for 6 months post-transplant and CMV-PCR monitoring. CMV-Tc was measured by intracellular IFNγ flow cytometry, when possible, at baseline, 1 month after CMV viremia (>5 copies/PCR) and serially until CMV-Tc was positive (≥0.2%). RESULTS Viremia rates at 1, 2, and 4 years post-transplant were higher in LDA vs. NLDA (46.3% vs. 7.2%, 64.2% vs. 7.2%, and 64.2% vs. 7.2%, respectively; p = .002). Viremia rates at these time points in seronegative LDA (50.3%, 71.6%, 71.6%) were significantly or near significantly higher than seronegative NLDA (9.1%, 9.1%, 9.1%; p = .004), seropositive-LDA (22.3%, 22.3%, 22.3%; p = .07), or seropositive NLDA (0%, 0%, 0%; p = .07). Eleven of 17 (64.7%) viremic subjects required valganciclovir dose reduction during the prophylaxis period for leukopenia. All viremic LDA patients developed CMV-Tc. One viremic NLDA patient did not develop CMV-Tc. No patients developed CMV disease. CONCLUSION CMV seronegative pediatric renal transplant patients receiving LDA are more likely to have valganciclovir prophylaxis dose reduction and develop subclinical CMV viremia; however, all developed CMV-Tc. Larger prospective studies are needed to further understand the effects of induction agents on CMV-Tc and CMV-Tc's role post-transplant.
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Affiliation(s)
- Helen Pizzo
- Pediatric Nephrology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Bongha Shin
- Transplant Immunology Laboratory and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jon Garrison
- Transplant Immunology Laboratory and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Edmund Huang
- Transplant Immunology Laboratory and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mohammad Malekzadeh
- Pediatric Nephrology, University of California Los Angeles, Los Angeles, CA, USA
| | - Stanley C Jordan
- Transplant Immunology Laboratory and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Dechu Puliyanda
- Pediatric Nephrology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mieko Toyoda
- Transplant Immunology Laboratory and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Higdon LE, Schaffert S, Cohen RH, Montez-Rath ME, Lucia M, Saligrama N, Margulies KB, Martinez OM, Tan JC, Davis MM, Khatri P, Maltzman JS. Functional Consequences of Memory Inflation after Solid Organ Transplantation. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2021; 207:2086-2095. [PMID: 34551963 PMCID: PMC8492533 DOI: 10.4049/jimmunol.2100405] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/04/2021] [Indexed: 11/19/2022]
Abstract
CMV is a major infectious complication following solid organ transplantation. Reactivation of CMV leads to memory inflation, a process in which CD8 T cells expand over time. Memory inflation is associated with specific changes in T cell function, including increased oligoclonality, decreased cytokine production, and terminal differentiation. To address whether memory inflation during the first year after transplantation in human subjects alters T cell differentiation and function, we employed single-cell-matched TCRαβ and targeted gene expression sequencing. Expanded T cell clones exhibited a terminally differentiated, immunosenescent, and polyfunctional phenotype whereas rare clones were less differentiated. Clonal expansion occurring between pre- and 3 mo posttransplant was accompanied by enhancement of polyfunctionality. In contrast, polyfunctionality and differentiation state were largely maintained between 3 and 12 mo posttransplant. Highly expanded clones had a higher degree of polyfunctionality than rare clones. Thus, CMV-responsive CD8 T cells differentiated during the pre- to posttransplant period then maintained their differentiation state and functional capacity despite posttransplant clonal expansion.
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Affiliation(s)
- Lauren E Higdon
- Department of Medicine/Nephrology, Stanford University, Palo Alto, CA
| | - Steven Schaffert
- Institute for Immunity, Transplantation and Infection, Stanford University, Stanford, CA
- Department of Medicine/Biomedical Informatics, Stanford University, Stanford, CA; and
| | - Rachel H Cohen
- Department of Medicine/Nephrology, Stanford University, Palo Alto, CA
| | | | - Marc Lucia
- Department of Surgery, Stanford University, Stanford, CA
| | - Naresha Saligrama
- Department of Microbiology and Immunology, Stanford University, Stanford CA
| | - Kenneth B Margulies
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Jane C Tan
- Department of Medicine/Nephrology, Stanford University, Palo Alto, CA
| | - Mark M Davis
- Institute for Immunity, Transplantation and Infection, Stanford University, Stanford, CA
- Howard Hughes Medical Institute, Stanford University School of Medicine, Stanford, CA; and
| | - Purvesh Khatri
- Institute for Immunity, Transplantation and Infection, Stanford University, Stanford, CA
- Department of Medicine/Biomedical Informatics, Stanford University, Stanford, CA; and
| | - Jonathan S Maltzman
- Department of Medicine/Nephrology, Stanford University, Palo Alto, CA;
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
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6
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Higdon LE, Schaffert S, Huang H, Montez-Rath ME, Lucia M, Jha A, Saligrama N, Margulies KB, Martinez OM, Davis MM, Khatri P, Maltzman JS. Evolution of Cytomegalovirus-Responsive T Cell Clonality following Solid Organ Transplantation. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2021; 207:2077-2085. [PMID: 34551964 PMCID: PMC8492537 DOI: 10.4049/jimmunol.2100404] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/04/2021] [Indexed: 12/30/2022]
Abstract
CMV infection is a significant complication after solid organ transplantation. We used single cell TCR αβ sequencing to determine how memory inflation impacts clonality and diversity of the CMV-responsive CD8 and CD4 T cell repertoire in the first year after transplantation in human subjects. We observed CD8 T cell inflation but no changes in clonal diversity, indicating homeostatic stability in clones. In contrast, the CD4 repertoire was diverse and stable over time, with no evidence of CMV-responsive CD4 T cell expansion. We identified shared CDR3 TCR motifs among patients but no public CMV-specific TCRs. Temporal changes in clonality in response to transplantation and in the absence of detectable viral reactivation suggest changes in the repertoire immediately after transplantation followed by an expansion with stable clonal competition that may mediate protection.
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Affiliation(s)
- Lauren E Higdon
- Nephrology Division, Department of Medicine, Stanford University, Palo Alto, CA
| | - Steven Schaffert
- Institute for Immunity, Transplantation and Infection, Stanford University, Stanford, CA
- Biomedical Informatics Division, Department of Medicine, Stanford University, Stanford, CA
| | - Huang Huang
- Department of Microbiology and Immunology, Stanford University, Stanford CA
| | - Maria E Montez-Rath
- Nephrology Division, Department of Medicine, Stanford University, Palo Alto, CA
| | - Marc Lucia
- Department of Surgery, Stanford University, Stanford, CA
| | - Alokkumar Jha
- Cardiovascular Institute, Stanford University, Stanford, CA
| | - Naresha Saligrama
- Department of Microbiology and Immunology, Stanford University, Stanford CA
| | - Kenneth B Margulies
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Mark M Davis
- Institute for Immunity, Transplantation and Infection, Stanford University, Stanford, CA
- Howard Hughes Medical Institute, Stanford University School of Medicine, Stanford University, Stanford, CA; and
| | - Purvesh Khatri
- Institute for Immunity, Transplantation and Infection, Stanford University, Stanford, CA
- Biomedical Informatics Division, Department of Medicine, Stanford University, Stanford, CA
| | - Jonathan S Maltzman
- Nephrology Division, Department of Medicine, Stanford University, Palo Alto, CA;
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
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7
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Higdon LE, Gustafson CE, Ji X, Sahoo MK, Pinsky BA, Margulies KB, Maecker HT, Goronzy J, Maltzman JS. Association of Premature Immune Aging and Cytomegalovirus After Solid Organ Transplant. Front Immunol 2021; 12:661551. [PMID: 34122420 PMCID: PMC8190404 DOI: 10.3389/fimmu.2021.661551] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/26/2021] [Indexed: 12/19/2022] Open
Abstract
Immune function is altered with increasing age. Infection with cytomegalovirus (CMV) accelerates age-related immunological changes resulting in expanded oligoclonal memory CD8 T cell populations with impaired proliferation, signaling, and cytokine production. As a consequence, elderly CMV seropositive (CMV+) individuals have increased mortality and impaired responses to other infections in comparison to seronegative (CMV–) individuals of the same age. CMV is also a significant complication after organ transplantation, and recent studies have shown that CMV-associated expansion of memory T cells is accelerated after transplantation. Thus, we investigated whether immune aging is accelerated post-transplant, using a combination of telomere length, flow cytometry phenotyping, and single cell RNA sequencing. Telomere length decreased slightly in the first year after transplantation in a subset of both CMV+ and CMV– recipients with a strong concordance between CD57+ cells and short telomeres. Phenotypically aged cells increased post-transplant specifically in CMV+ recipients, and clonally expanded T cells were enriched for terminally differentiated cells post-transplant. Overall, these findings demonstrate a pattern of accelerated aging of the CD8 T cell compartment in CMV+ transplant recipients.
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Affiliation(s)
- Lauren E Higdon
- Department of Medicine/Nephrology, Stanford University, Palo Alto, CA, United States
| | - Claire E Gustafson
- Department of Medicine/Immunology & Rheumatology, Stanford University, Palo Alto, CA, United States
| | - Xuhuai Ji
- Human Immune Monitoring Center, Stanford University, Palo Alto, CA, United States
| | - Malaya K Sahoo
- Department of Pathology, Stanford University, Palo Alto, CA, United States
| | - Benjamin A Pinsky
- Department of Pathology, Stanford University, Palo Alto, CA, United States.,Department of Medicine/Infectious Diseases and Geographic Medicine, Stanford University, Palo Alto, CA, United States
| | - Kenneth B Margulies
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Holden T Maecker
- Human Immune Monitoring Center, Stanford University, Palo Alto, CA, United States.,Department of Microbiology & Immunology, Stanford University, Palo Alto, CA, United States
| | - Jorg Goronzy
- Department of Medicine/Immunology & Rheumatology, Stanford University, Palo Alto, CA, United States.,Department of Medicine, VA Palo Alto Health Care System, Palo Alto, CA, United States
| | - Jonathan S Maltzman
- Department of Medicine/Nephrology, Stanford University, Palo Alto, CA, United States.,Department of Medicine, VA Palo Alto Health Care System, Palo Alto, CA, United States
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8
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Virus-specific T cells in pediatric renal transplantation. Pediatr Nephrol 2021; 36:789-796. [PMID: 32221706 PMCID: PMC7910244 DOI: 10.1007/s00467-020-04522-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/25/2020] [Accepted: 02/25/2020] [Indexed: 12/15/2022]
Abstract
After pediatric kidney transplantation, immunosuppressive therapy causes an increased risk of severe viral complications, especially from cytomegalovirus (CMV), BK polyomavirus (BKPyV) or Epstein-Barr virus (EBV), and less frequent from adenovirus (ADV). However, suitable predictive markers for the individual outcome of viral infections are missing and the therapeutic management remains a challenge to the success of pediatric kidney transplantation. Virus-specific T cells are known for controlling viral replication and there is growing evidence that virus-specific T cells may serve as a prognostic marker to identify patients at risk for viral complications. This review provides an overview of the usability of virus-specific T cells for improving diagnostic and therapeutic management of viral infections with reference to the necessity of antiviral prophylaxis, timing of pre-emptive therapy, and dosing of immunosuppressive medication after pediatric kidney transplantation. Several studies demonstrated that high levels of virus-specific T cells are associated with decrease of virus load and favorable outcome, whereas lack of virus-specific T cells coincided with virus-induced complications. Accordingly, the additional monitoring of virus-specific T cells aims to personalize the management of antiviral therapy, identify overimmunosuppression, and avoid unnecessary therapeutic interventions. Prospective randomized trials in pediatric kidney recipients comparing standard antiviral and immunosuppressive regimens with T cell-guided therapeutic interventions are needed, before monitoring of virus-specific T cells is implemented in the routine care of pediatric kidney graft recipients.
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Páez-Vega A, Cantisán S, Agüera ML, Suñer M, Facundo C, Yuste JR, Fernández-Ruiz M, Montejo M, Redondo-Pachón D, López-Oliva MO, Fernández-Rodríguez A, Fariñas MC, Hernández D, Len O, Muñoz P, Valle-Arroyo J, Rodelo-Haad C, Cordero E, Torre-Cisneros J. Pretransplant CMV-Specific T-Cell Immunity But Not Dose of Antithymocyte Globulin Is Associated With Recovery of Specific Immunity After Kidney Transplantation. J Infect Dis 2020; 223:1205-1213. [PMID: 32779713 DOI: 10.1093/infdis/jiaa503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/04/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND This is a prospective, multicenter, observational study in cytomegalovirus (CMV)-seropositive kidney transplant recipients with pretransplant CMV-specific cell-mediated immunity (CMV-CMI) receiving antithymocyte globulin (ATG). We aimed to investigate posttransplant CMV-CMI over time and the impact of the dose-dependent ATG. METHODS CMV-CMI was assessed at days +30, +45, +60, and +90 after transplantation with the QuantiFERON-CMV assay. A reactive result (interferon-γ [IFN-γ] ≥ 0.2 IU/mL) indicated a positive CMV-CMI. RESULTS A total of 78 positive CMV-CMI patients were enrolled in the study, of which 59.5% had a positive CMV-CMI at day +30 and 82.7% at day +90. Multivariate logistic regression analysis showed that ATG dose was not associated with positive CMV-CMI at any point. However, pretransplant IFN-γ level (>12 IU/mL vs ≤12 IU/mL) was associated with positive CMV-CMI at day +30 (odds ratio, 12.9; 95% confidence interval, 3.1-53.3; P < .001). In addition, all the patients who did not recover CMV-CMI at day +90 had a pretransplant IFN-γ level ≤12 IU/mL. CONCLUSIONS More than half of CMV-seropositive kidney transplant recipients receiving ATG recover (or maintain) CMV-CMI by the first month after transplantation. The pretransplant IFN-γ level, but not the ATG dose, shows a strong association with the kinetics of this recovery.
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Affiliation(s)
- Aurora Páez-Vega
- Maimónides Institute for Biomedical Research of Cordoba (IMIBIC), Reina Sofía University Hospital, University of Cordoba, Cordoba, Spain.,Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - Sara Cantisán
- Maimónides Institute for Biomedical Research of Cordoba (IMIBIC), Reina Sofía University Hospital, University of Cordoba, Cordoba, Spain.,Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain.,Infectious Diseases Service, Reina Sofia University Hospital, Cordoba, Spain
| | - Maria L Agüera
- Maimónides Institute for Biomedical Research of Cordoba (IMIBIC), Reina Sofía University Hospital, University of Cordoba, Cordoba, Spain.,Nephrology Service, Reina Sofia University Hospital, Cordoba, Spain
| | - Marta Suñer
- Nephrology Service, Virgen del Rocío University Hospital, Seville, Spain
| | | | - Jose R Yuste
- Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain.,Infectious Diseases Unit, University Clinic of Navarra, Pamplona, Spain
| | - Mario Fernández-Ruiz
- Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain.,Unit of Infectious Diseases, Research Institute Hospital 12 de Octubre, Madrid, Spain
| | - Miguel Montejo
- Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain.,Infectious Diseases Service, Cruces University Hospital, Bilbao, Spain
| | | | | | | | - Maria C Fariñas
- Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain.,Infectious Diseases Service, Marqués de Valdecilla Hospital, University of Cantabria, Instituto de Investigación Marqués de Valdecilla, Santander, Spain
| | - Domingo Hernández
- Nephrology Service, Regional University Hospital "Carlos Haya," Institute for Biomedical Research of Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Oscar Len
- Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain.,Infectious Diseases Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Gregorio Marañon University Hospital; Instituto de Investigación Biomédica Gregorio Marañón; Universidad Complutense de Madrid, Madrid, Spain. CIBERES (CB06/06/0058), Madrid, Spain.,Instituto de Investigación Biomédica Gregorio Marañón, Madrid, Spain.,Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Jorge Valle-Arroyo
- Maimónides Institute for Biomedical Research of Cordoba (IMIBIC), Reina Sofía University Hospital, University of Cordoba, Cordoba, Spain.,Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - Cristian Rodelo-Haad
- Maimónides Institute for Biomedical Research of Cordoba (IMIBIC), Reina Sofía University Hospital, University of Cordoba, Cordoba, Spain.,Nephrology Service, Reina Sofia University Hospital, Cordoba, Spain
| | - Elisa Cordero
- Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain.,Infectious Diseases Unit, Virgen del Rocío University Hospital, Seville, Spain
| | - Julián Torre-Cisneros
- Maimónides Institute for Biomedical Research of Cordoba (IMIBIC), Reina Sofía University Hospital, University of Cordoba, Cordoba, Spain.,Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain.,Infectious Diseases Service, Reina Sofia University Hospital, Cordoba, Spain
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Kaminski H, Jarque M, Halfon M, Taton B, Di Ascia L, Pfirmann P, Visentin J, Garrigue I, Déchanet-Merville J, Moreau JF, Crespo E, Montero N, Melilli E, Meneghini M, Pascual M, Couzi L, Manuel O, Bestard O, Merville P. Different impact of rATG induction on CMV infection risk in D+R- and R+ KTRs. J Infect Dis 2020; 220:761-771. [PMID: 31157865 DOI: 10.1093/infdis/jiz194] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 04/24/2019] [Indexed: 12/12/2022] Open
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.
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Affiliation(s)
- Hannah Kaminski
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Pellegrin University Hospital, Bordeaux, France.,CNRS-UMR 5164 ImmunoConcEpT, Bordeaux University, Bordeaux, France
| | - Marta Jarque
- Experimental Nephrology Laboratory, IDIBELL, Barcelona, Spain
| | - Mathieu Halfon
- Transplantation Center, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Benjamin Taton
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Pellegrin University Hospital, Bordeaux, France
| | - Ludovic Di Ascia
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Pellegrin University Hospital, Bordeaux, France
| | - Pierre Pfirmann
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Pellegrin University Hospital, Bordeaux, France
| | - Jonathan Visentin
- CNRS-UMR 5164 ImmunoConcEpT, Bordeaux University, Bordeaux, France.,Laboratory of Immunology, and Immunogenetics Pellegrin University Hospital, Bordeaux, France
| | - Isabelle Garrigue
- Laboratory of Virology, Pellegrin University Hospital, Bordeaux, France
| | | | | | - Elena Crespo
- Experimental Nephrology Laboratory, IDIBELL, Barcelona, Spain
| | - Nuria Montero
- Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Edoardo Melilli
- Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Maria Meneghini
- Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Manuel Pascual
- Transplantation Center, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Lionel Couzi
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Pellegrin University Hospital, Bordeaux, France.,CNRS-UMR 5164 ImmunoConcEpT, Bordeaux University, Bordeaux, France
| | - Oriol Manuel
- Transplantation Center, Lausanne University Hospital and University of Lausanne, Switzerland.,Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Oriol Bestard
- Experimental Nephrology Laboratory, IDIBELL, Barcelona, Spain.,Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Pierre Merville
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Pellegrin University Hospital, Bordeaux, France.,CNRS-UMR 5164 ImmunoConcEpT, Bordeaux University, Bordeaux, France
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