Key result
A robust cellular response to both IE1 and pp65 antigens protected CMV seropositive renal transplant recipients from high-level viremia compared to responding to one or neither (0/28 vs 5/25; p<0.02).
Why the study?
Does the T-SPOT.CMV assay predict CMV viremia and disease in renal transplant recipients?
Cohort (n=108)
Double-blind
No
Does the T-SPOT.CMV assay predict CMV viremia and disease in renal transplant recipients?
Absolute Event Rate: 0% vs 20%
p-value: p=<0.02
In CMV seropositive renal transplant recipients, a dual cellular immune response to IE1 and pp65 measured by T-SPOT.CMV is associated with protection from subsequent high-level CMV viremia.
This is the authors' abstract. We don't add key points for this paper.
BACKGROUND: The measurement of CMV specific cellular immunity in organ transplant recipients could contribute additional acuity to serology based, CMV infection risk stratification, facilitating optimisation of immunosuppression and anti-viral prophylaxis. METHODS: A pilot study of renal transplant recipient (RTR's) responses in the T-SPOT.CMV ELISPOT based assay. 108 RTR's were recruited 3 months post-transplantation, immediately prior to the cessation of stratified anti-viral prophylaxis, used in recipients from seropositive donors. RTR's were monitored for CMV viremia and disease. Cellular responses to peptides derived from CMV IE1 and pp65 were measured, using the T-SPOT.CMV assay. RESULTS: At recruitment, no CMV specific cellular immunity was detected by T-SPOT.CMV in CMV seronegative recipients (IE1 ≤ 1spot / 2.5x105 PBMC's; pp65 ≤ 3 spots / 2.5x105 PBMC's). At recruitment, CMV sero-positive recipients who made a robust response to both IE1 (>25 spots / 2.5x105 PBMC's) and pp65 (>50 spots / 2.5x105 PBMC's), were less likely to develop high level viremia than those who responded to one or neither antigen (0/28 vs 5/25; p<0.02). CONCLUSIONS: In CMV seronegative RTR's, CMV specific cellular immunity measured by T-SPOT.CMV was not detected prior to cessation of anti-viral prophylaxis. This differs from recent reports of CMV specific cellular immunity in a proportion of CMV seronegative RTR's, associated with protection from CMV infection. In seropositive RTR's, a dual response to IE1 and pp65 at recruitment, was associated with protection from subsequent viremia. This suggests that assessing the diversity of response to CMV antigens, may enhance risk stratification in this group.
Dual response on T-SPOT.CMV was associated with protection from high-level viremia; leaves open whether assay use alters outcomes in renal transplant recipients.
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Chanouzas et al. (2018) conducted a cohort in Renal transplant recipients at risk of CMV infection (n=108). Robust cellular response to both IE1 and pp65 antigens vs. Response to one or neither antigen was evaluated on High level CMV viremia (>5000 copies/ml) (p=<0.02). A robust cellular response to both IE1 and pp65 antigens protected CMV seropositive renal transplant recipients from high-level viremia compared to responding to one or neither (0/28 vs 5/25; p<0.02).
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