Comparison of Humoral and Cellular CMV Immunity in Patients Awaiting Kidney Transplantation

Abstract

Chronic kidney disease may alter antiviral T cell immunity. In the current study, we assessed in 63 patients prior to kidney transplantation how humoral and cellular immunity against cytomegalovirus (CMV) correlated using an interferon (IFN)-γ ELISpot (T-Track® CMV, Mikrogen, Neuried, Germany). The cohort comprised 24 patients with negative and 39 with positive CMV IgG. Whereas none of the patients with negative CMV IgG showed detectable responses to the T-Track® CMV, 26 out of 39 patients with positive CMV IgG had positive ELISpot responses. The median response to CMV pp65 in the CMV seronegative group was 0 spot forming units (SFU) per 200,000 PBMC (range 0–1) and in the seropositive group 43 SFU (range 0–750). Thus, 13 out of 39 patients with positive CMV serostatus (33%) had undetectable T cell immunity and may be at an increased risk of CMV reactivation. CMV pp65-specific ELISpot responses were 29.3-fold higher in seropositive patients with vs. without dialysis and 5.6-fold higher in patients with vs. without immunosuppressive therapy, but patients with dialysis and immunosuppressive therapy showed, as expected, lower responses to phytohemagglutinin, the positive control. This finding may be caused by (subclinical) CMV-DNAemia and a “booster” of CMV-specific T cells.

Prospective, Longitudinal Study on Specific Cellular Immune Responses after Vaccination with an Adjuvanted, Recombinant Zoster Vaccine in Kidney Transplant Recipients

“…An increased frequency of these specific T cells may result in stronger VZV-specific ELISpot responses at baseline if it is closer to transplantation. This hypothesis is supported by the fact that we observed stronger cellular responses towards CMV in dialysis patients with vs. without immunosuppressive treatment [25] and a higher rate of CMV-specific proliferative responses in hematopoietic stem cell transplant recipients vs. healthy controls [26]. Another unexpected finding, the positive correlation of treatment with tacrolimus or mycophenolate and increased VZV-specific ELISpot responses, may have been caused by a similar phenomenon: (subclinical) VZV reactivation.…”