Absolute Lymphocyte Count: A Predictor of Recurrent Cytomegalovirus Disease in Solid Organ Transplant Recipients

Abstract

Low ALC at the time of CMV treatment completion was a strong independent predictor for recurrent CMV disease. This finding is biologically plausible given the known importance of T-cell immunity in maintaining CMV latency. Future studies should consider this inexpensive, readily available marker of host immunity.

Nuclear factor of activated T cells as potential pharmacodynamic biomarker for the risk of acute and subclinical rejection in de novo liver recipients

“…Despite the usefulness of measuring NFAT‐RGE to assess the risk of CMV infection, there is a potential clinical confounding factor that should be considered. CMV infection has been described to produce a high percentage of patients with lymphopenia, and an association between the absolute lymphocyte count and recurrence of CMV has been established . Therefore, it cannot be ruled out that the reported strong inhibition of NFAT‐RGE in patients with CMV infection by some groups is not only an exclusively direct effect of Tac or CsA but also a consequence of the significant decrease in the number of lymphocytes during the infection process.…”

“…CMV infection has been described to produce a high percentage of patients with lymphopenia, 35 and an association between the absolute lymphocyte count and recurrence of CMV has been established. 36,37 Therefore, it cannot be ruled out that the reported strong inhibition of NFAT-RGE in Considering the possible implementation of the measurement of NFAT-RGE in routine clinical practice setting, to the best of our knowledge, only one analytical validation and cross-validation of the NFAT-RGE assay has been reported. 38 Although the results are promising, there is a need for interlaboratory analytical cross-validation and comprehensive standardization of all the analytical processes in which more than two centres participate and with a larger number of samples.…”

The impact of recurrent cytomegalovirus infection on long‐term survival in solid organ transplant recipients

“…If there truly is an association between recurrent CMV and death, then strategies to reduce recurrence could be implemented, such as longer courses of antiviral therapy, extended secondary prophylaxis, or more frequent virologic monitoring after treatment completion with prompt preemptive antiviral recommencement prior to the development of symptoms . With improved risk stratification using biomarkers or immune monitoring assays, patients at the highest risk of relapse could be targeted more specifically with these kinds of interventions …”

“…However, post‐prophylaxis (late‐onset) CMV reactivation still occurs, contributing to graft loss and premature death via its direct and indirect effects . Recurrent disease occurs in up to 30% of patients despite successful treatment for CMV, and while significant efforts have been made to identify risk factors for relapse and implement strategies to reduce it, these seem to have had minimal impact on recurrence rates . While it is clear from prior studies that patients who develop CMV disease have a higher risk of death than those who do not, the impact of recurrent disease on survival is less well characterized.…”

“…We have previously shown that secondary prophylaxis delays but do not prevent relapse, and that low absolute lymphocyte count at the time of CMV treatment completion is associated with recurrence . The aim of this study was to explore the impact of recurrent CMV infection on long‐term survival in a retrospective cohort of heart, liver, and kidney transplant recipients.…”