99279 20210902121943.0 doi 10.1093/cid/ciz1209 sideral 122432 ART-2020-122432 eng Jarque, M. Cellular Immunity to Predict the Risk of Cytomegalovirus Infection in Kidney Transplantation: A Prospective, Interventional, Multicenter Clinical Trial 2020 Access copy available to the general public Unrestricted Background: Improving cytomegalovirus (CMV) immune-risk stratification in kidney transplantation is highly needed to establish guided preventive strategies. Methods: This prospective, interventional, multicenter clinical trial assessed the value of monitoring pretransplant CMV-specific cell-mediated immunity (CMI) using an interferon-γrelease assay to predict CMV infection in kidney transplantation. One hundred sixty donor/recipient CMV-seropositive (D+/R+) patients, stratified by their baseline CMV (immediate-early protein 1)-specific CMI risk, were randomized to receive either preemptive or 3-month antiviral prophylaxis. Also, 15-day posttransplant CMI risk stratification and CMI specific to the 65 kDa phosphoprotein (pp65) CMV antigen were investigated. Immunosuppression consisted of basiliximab, tacrolimus, mycophenolate mofetil, and corticosteroids in 80% of patients, whereas 20% received thymoglobulin induction therapy. Results: Patients at high risk for CMV based on pretransplant CMI developed significantly higher CMV infection rates than those deemed to be at low risk with both preemptive (73.3% vs 44.4%; odds ratio [OR], 3.44 [95% confidence interval {CI}, 1.30-9.08]) and prophylaxis (33.3% vs 4.1%; OR, 11.75 [95% CI, 2.31-59.71]) approaches. The predictive capacity for CMV-specific CMI was only found in basiliximab-treated patients for both preemptive and prophylaxis therapy. Fifteen-day CMI risk stratification better predicted CMV infection (81.3% vs 9.1%; OR, 43.33 [95% CI, 7.89-237.96]). Conclusions: Pretransplant CMV-specific CMI identifies D+/R+ kidney recipients at high risk of developing CMV infection if not receiving T-cell-depleting antibodies. Monitoring CMV-specific CMI soon after transplantation further defines the CMV infection prediction risk. Monitoring CMV-specific CMI may guide decision making regarding the type of CMV preventive strategy in kidney transplantation. Clinical Trials Registration: NCT02550639. info:eu-repo/grantAgreement/EUR/ERDF/A way to build Europe info:eu-repo/grantAgreement/ES/ISCIII/ICI14-00242 info:eu-repo/grantAgreement/ES/ISCIII/PI16-01321 info:eu-repo/semantics/openAccess All rights reserved http://www.europeana.eu/rights/rr-f/ 9.079 2020 IMMUNOLOGY 18 / 162 = 0.111 2020 Q1 T1 MICROBIOLOGY 12 / 136 = 0.088 2020 Q1 T1 INFECTIOUS DISEASES 3 / 92 = 0.033 2020 Q1 T1 3.44 2020 Microbiology (medical) 2020 Q1 Infectious Diseases 2020 Q1 info:eu-repo/semantics/article info:eu-repo/semantics/acceptedVersion Crespo, E. Melilli, E. Gutiérrez, A. Universidad de Zaragoza (orcid)0000-0002-2253-7779 Moreso, F. Guirado, L. Revuelta, I. Montero, N. Torras, J. Riera, L. Meneghini, M. Taco, O. Manonelles, A. Paul, J. Universidad de Zaragoza (orcid)0000-0002-0175-3739 Seron, D. Facundo, C. Cruzado, J.M. Gil Vernet, S. Grinyó, J.M. Bestard, O. 1007 610 Universidad de Zaragoza Dpto. Medicina, Psiqu. y Derm. Area Medicina 71, 9 (2020), 2375-2385 Clin. infect. dis. CLINICAL INFECTIOUS DISEASES 1058-4838 468499 http://zaguan.unizar.es/record/99279/files/texto_completo.pdf Postprint 3116452 http://zaguan.unizar.es/record/99279/files/texto_completo.jpg?subformat=icon icon Postprint oai:zaguan.unizar.es:99279 articulos driver 2021-09-02-11:01:50 ARTICLE