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Analysis of spontaneous resolution of cytomegalovirus replication after transplantation in CMV-seropositive patients with pretransplant CD8+IFNG+ response

2018; Elsevier BV; Volume: 155; Linguagem: Inglês

10.1016/j.antiviral.2018.05.006

1872-9096

Aurora Páez-Vega, Antonio Poyato, Alberto Rodríguez‐Benot, Lluís Guirado, Jesús Fortün, Òscar Len, Edson Abdala, María Carmen Fariñas, Elisa Cordero, Carmen de Gracia, Domingo Hernández, Rafael González Manzanares, Julián Torre‐Cisneros, Sara Cantisán, Aurora Páez-Vega, Alberto Rodríguez‐Benot, Jesús Fortün, Òscar Len, María Carmen Fariñas, Elisa Cordero, Julián Torre‐Cisneros, Alberto Rodríguez‐Benot, Lluís Guirado, Domingo Hernández,

Toxoplasma gondii Research Studies

This prospective study evaluates whether CMV-seropositive (R+) transplant patients with pretransplant CD8+IFNG+ T-cell response to cytomegalovirus (CMV) (CD8+IFNG+ response) can spontaneously clear the CMV viral load without requiring treatment.A total of 104 transplant patients (kidney/liver) with pretransplant CD8+IFNG+ response were evaluable.This response was determined using QuantiFERON-CMV assay.The incidence of CMV replication and disease was 45.2% (47/104) and 6.7% (7/104), respectively.Of the total patients, 77.9% (81/104) did not require antiviral treatment, either because they did not have CMV replication (n = 57) or because they had asymptomatic CMV replication that could be spontaneously cleared (n = 24).Both situations are likely related to the presence of CD8+IFNG+ response to CMV, which has a key role in controlling CMV infection.However, 22.1% of the patients (23/104) received antiviral treatment, although only 7 of them did so because they had symptomatic CMV replication.These patients developed symptoms in spite of having pretransplant CD8+IFNG+ response, thus suggesting that other immunological parameters might be involved, such as a dysfunctional CD4+ response, or that they might have become QFNon-reactive due to the immunosuppression.In conclusion, around at least 80% of R+ patients with pretransplant CD8+IFNG+ response to CMV did not require antiviral treatment, although this percentage might be underestimated.Nevertheless, we recommend performing an additional CD8+IFNG+ response determination at posttransplant time to provide more reliable information regarding the patients who will be able to spontaneously clear the viremia.