Human CMV-specific T-cell responses in kidney transplantation; toward changing current risk-stratification paradigm

Abstract

Summary Despite the great efficacy of current antiviral preventive strategies, hCMV infection is still a major complication after renal transplantation, significantly challenging patient and graft survival. This issue seems to be explained because of the rather poor immunologic monitoring of the antiviral immune response. An important body of evidence has shown that monitoring the hCMV‐specific T‐cell response, at different time points of the transplant setting, seems to add crucial information for predicting the risk of viral infection, thus potentially helping individualization of therapeutic decision‐making in clinical transplantation. While several immune‐cellular assays have shown its capability for accurately monitoring hCMV‐specific T‐cell responses, only few such as the IFN‐γ ELISPOT and the ELISA based technology assays might be reliable for its application in the clinic. Nonetheless, an important effort has to be made among the transplant community to standardize and validate such immune assays. Noteworthy, large‐scale prospective randomized trials are highly warranted to ultimately introduce them in current clinical practice as a part of the highly desired personalized medicine.

Cytomegalovirus prophylaxis in seropositive renal transplant recipients receiving thymoglobulin induction therapy: Outcome and risk factors for late CMV disease

“…T‐Cell immune response is the main mechanism for CMV control. A low number of both CMV‐specific memory and effector T cells is an important risk factor for CMV disease, which is presumed here by the low TLC. Fernández‐Ruiz et al.…”

“…Anti‐thymocyte globulin is a known risk factor for CMV disease . Our group previously showed, as a secondary outcome, a 33% incidence of CMV disease in ATG‐induction kidney transplants given 90 days of prophylaxis with IV‐GCV .…”

“…Anti-thymocyte globulin is a known risk factor for CMV disease. [14][15][16] Our group previously showed, as a secondary outcome, a 33% incidence of CMV disease in ATG-induction kidney transplants given 90 days of prophylaxis with IV-GCV. 17 Except for the study from Jamal et al, other studies on CMV prophylaxis that show lateonset disease occurrence involve mostly D+/R-patients [18][19][20][21][22][23] or have too few patients receiving ATG.…”

“…A low number of both CMV-specific memory and effector T cells is an important risk factor for CMV disease, 15,16 There is no clear explanation for a low eGFR being a risk factor for CMV disease. Studies that found this association were not assertive about the mechanisms.…”

Approaches for monitoring of non virus-specific and virus-specific T-cell response in solid organ transplantation and their clinical applications

“…Quantification and monitoring of HCMV-specific T-cell responses using different assays have been evaluated to predict infection and/or disease in SOT recipients [77][78][79][80][81]. Indeed the latest consensus guidelines on HCMV in SOT recommended these methods as an adjunct tool to predict risk of viremia and disease [21].…”