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      Pretransplant immediately early-1-specific T cell responses provide protection for CMV infection after kidney transplantation.

      American Journal of Transplantation
      Antigens, Viral, blood, immunology, Antiviral Agents, therapeutic use, Cytomegalovirus, Cytomegalovirus Infections, metabolism, prevention & control, Female, Follow-Up Studies, Graft Survival, Humans, Immediate-Early Proteins, Kidney Transplantation, Male, Middle Aged, Preoperative Period, Prognosis, Retrospective Studies, T-Lymphocytes, pathology

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          Abstract

          Cytomegalovirus (CMV) infection is still a major complication after kidney transplantation. Although cytotoxic CMV-specific T cells play a crucial role controlling CMV survival and replication, current pretransplant risk assessment for CMV infection is only based on donor/recipient (IgG)-serostatus. Here, we evaluated the usefulness of monitoring pre- and 6-month CMV-specific T cell responses against two dominant CMV antigens (IE-1 and pp65) and a CMV lysate, using an IFN-γ Elispot, for predicting the advent of CMV infection in two cohorts of 137 kidney transplant recipients either receiving routine prophylaxis (n = 39) or preemptive treatment (n = 98). Incidence of CMV antigenemia/disease within the prophylaxis and preemptive group was 28%/20% and 22%/12%, respectively. Patients developing CMV infection showed significantly lower anti-IE-1-specific T cell responses than those that did not in both groups (p < 0.05). In a ROC curve analysis, low pretransplant anti-IE-1-specific T cell responses predicted the risk of both primary and late-onset CMV infection with high sensitivity and specificity (AUC > 0.70). Furthermore, when using most sensitive and specific Elispot cut-off values, a higher than 80% and 90% sensitivity and negative predictive value was obtained, respectively. Monitoring IE-1-specific T cell responses before transplantation may be useful for predicting posttransplant risk of CMV infection, thus potentially guiding decision-making regarding CMV preventive treatment. © Copyright 2013 The American Society of Transplantation and the American Society of Transplant Surgeons.

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