Utilization of a CMV T Cell Immunity Assay to Guide Secondary Prophylaxis in Solid Organ Transplant Recipients

ABSTRACT Background Secondary prophylaxis following treatment of CMV infection in solid organ transplant recipients (SOTRs) may be considered in high‐risk SOTRs, although utilization criteria are not well described. The addition of CMV‐specific T‐cell immunity assay testing may help guide selection of SOTRs for secondary prophylaxis. Methods All SOTRs at a single center with CMV T‐cell assays obtained during secondary prophylaxis between January 2020 and August 2023 were reviewed. CMV antiviral secondary prophylaxis discontinuation rates and subsequent need for antiviral therapy re‐initiation were recorded. Positive predictive and negative predictive values of the assay, as well as the association between absolute lymphocyte count (ALC) and CMV T cell assay variables, were assessed. Results CMV T‐cell assay results in 32/78 (41%) SOTRs showed adequate response. Secondary prophylaxis was discontinued in 27 (84.4%) with adequate and 13 (28.2%) with inadequate T‐cell response ( p 0.5 10 9 /L at time of assay, an adequate T cell assay response was significantly associated with no CMV reactivation ( n = 0/22, p < 0.001). Conclusion In this exploratory population, the combination of an adequate CMV T‐cell assay with adequate ALC was strongly predictive of no CMV reactivation. Further investigation into the predictive characteristics of a CMV T‐cell assay combined with ALC and other patient‐specific factors may optimize its clinical application. image