Cellular Immunity to Predict the Risk of Cytomegalovirus Infection in Kidney Transplantation: A Prospective, Interventional, Multicenter Clinical Trial

Jarque, M. ; Crespo, E. ; Melilli, E. ; Gutiérrez, A. (Universidad de Zaragoza) ; Moreso, F. ; Guirado, L. ; Revuelta, I. ; Montero, N. ; Torras, J. ; Riera, L. ; Meneghini, M. ; Taco, O. ; Manonelles, A. ; Paul, J. (Universidad de Zaragoza) ; Seron, D. ; Facundo, C. ; Cruzado, J.M. ; Gil Vernet, S. ; Grinyó, J.M. ; Bestard, O.

Resumen: 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.

Idioma: Inglés

DOI: 10.1093/cid/ciz1209

Año: 2020

Publicado en: CLINICAL INFECTIOUS DISEASES 71, 9 (2020), 2375-2385
ISSN: 1058-4838

Factor impacto JCR: 9.079 (2020)

Categ. JCR: IMMUNOLOGY rank: 18 / 162 = 0.111 (2020) - Q1 - T1
Categ. JCR: MICROBIOLOGY rank: 12 / 136 = 0.088 (2020) - Q1 - T1
Categ. JCR: INFECTIOUS DISEASES rank: 3 / 92 = 0.033 (2020) - Q1 - T1

Factor impacto SCIMAGO: 3.44 - Microbiology (medical) (Q1) - Infectious Diseases (Q1)

Financiación: info:eu-repo/grantAgreement/EUR/ERDF/A way to build Europe
Financiación: info:eu-repo/grantAgreement/ES/ISCIII/ICI14-00242
Financiación: info:eu-repo/grantAgreement/ES/ISCIII/PI16-01321

Tipo y forma: Article (PostPrint)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)