The outcome was good, particularly in non-coinfected patients. Coinfected patients constitute an especially high-risk group for kidney transplantation.

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In this prospective study we analyzed pretransplant interferon-c secretion by cytomegalovirus (CMV)-specific CD8+ T cells to assess its possible utility in determining the risk of CMV replication after solid organ transplantation. A total of 113 lung and kidney transplant patients were enrolled in the study but only 55 were evaluable. All CMV-seronegative recipients were pretransplant "nonreactive" (IFNc <0.2 IU/mL) (11/11), whereas 30/44 (68.2%) CMV-seropositive (R+) recipients were "reactive" (IFNc ≥0.2 IU/mL) and 14/44 (31.8%) were "nonreactive" . In the R(+) "nonreactive" group, 7/14 (50%) developed posttransplant CMV replication, whereas the virus replicated only in 4/30 (13.3%) of the R(+) "reactive" patients (p = 0.021). According to the best multivariate model, pretransplant "nonreactive" recipients receiving an organ from a CMV-seropositive donor had a 10-fold increased risk of CMV replication compared to pretransplant "reactive" recipients (adjusted OR 10.49, 95% CI 1.88-58.46). This model displayed good discrimination ability (AUC 0.80) and calibration (Hosmer-Lemeshow test, p = 0.92). Negative and positive predictive values were 83.7% and 75%, respectively. The accuracy of the model was 82%. Therefore, assessment of interferon-c secretion by cytomegalovirus (CMV)-specific CD8+ T cells prior to transplantation is useful in informing the risk of posttransplant CMV replication in solid organ transplant patients.

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J o u r n a l P r e -p r o o f SPECIAL ARTICLE Recommendations on the management of the SARS-Co V-2 coronavirus pandemic (Covid-19) in kidney transplant patients Recomendaciones en el manejo de la pandemia por coronavirus SARS-CoV-2 (Covid-19) en pacientes con trasplante renal SUMMARY The SARS-CoV-2 (Covid-19) coronavirus pandemic is evolving very quickly and means a special risk for both immunosuppressed and comorbid patients. Knowledge about this growing infection is also increasing although many uncertainties remain, especially in the kidney transplant population. This manuscript presents a proposal for action with general and specific recommendations to protect and prevent infection in this vulnerable population such as kidney transplant recipients.RESUMEN La pandemia de coronavirus del SARS-CoV-2 (Covid-19) está evolucionando muy rápidamente y significa un riesgo especial para pacientes inmunosuprimidos y con comorbilidad.. El conocimiento sobre esta creciente infección también está aumentando, aunque Page 4 of 19 J o u r n a l P r e -p r o o f persisten muchas incertidumbres, especialmente en la población de trasplante de riñón. Este manuscrito presenta una propuesta de acción con recomendaciones generales y específicas para proteger y prevenir la infección en esta población vulnerable, como los receptores de trasplante de riñón. Palabras clave: Covid-19, trasplante renal, inmunodeprimido, SARS-CoV-2.