Cellular Immunity to Predict the Risk of Cytomegalovirus Infection in Kidney Transplantation: A Prospective, Interventional, Multicenter Clinical Trial
Por:
Jarque, M, Crespo, E, Melilli, E, Gutierrez, A, Moreso, F, Guirado, L, Revuelta, I, Montero, N, Torras, J, Riera, L, Meneghini, M, Taco, O, Manonelles, A, Paul, J, Seron, D, Facundo, C, Cruzado, JM, Vernet, SG, Grinyo, JM, Bestard, O
Publicada:
1 nov 2020
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-gamma release 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.
Filiaciones:
Jarque, M:
IDIBELL, Bellvitge Biomed Res Inst, Expt Nephrol Lab, Lhospitalet De Llobregat, Spain
Crespo, E:
IDIBELL, Bellvitge Biomed Res Inst, Expt Nephrol Lab, Lhospitalet De Llobregat, Spain
Melilli, E:
Bellvitge Univ Hosp, Nephrol Dept, Kidney Transplant Unit, Barcelona, Spain
Gutierrez, A:
Hosp Miguel Servet, Nephrol Dept, Kidney Transplant Unit, Zaragoza, Spain
Moreso, F:
Vall dHebron Univ Hosp, Nephrol Dept, Kidney Transplant Unit, Barcelona, Spain
Guirado, L:
Fundacio PuigVert, Kidney Transplant Unit, Nephrol Dept, Barcelona, Spain
Revuelta, I:
Hosp Clin Barcelona, Nephrol Dept, Kidney Transplant Unit, Barcelona, Spain
Montero, N:
Bellvitge Univ Hosp, Nephrol Dept, Kidney Transplant Unit, Barcelona, Spain
Torras, J:
IDIBELL, Bellvitge Biomed Res Inst, Expt Nephrol Lab, Lhospitalet De Llobregat, Spain
Bellvitge Univ Hosp, Nephrol Dept, Kidney Transplant Unit, Barcelona, Spain
Riera, L:
Bellvitge Univ Hosp, Urol Dept, Barcelona, Spain
Meneghini, M:
IDIBELL, Bellvitge Biomed Res Inst, Expt Nephrol Lab, Lhospitalet De Llobregat, Spain
Bellvitge Univ Hosp, Nephrol Dept, Kidney Transplant Unit, Barcelona, Spain
Taco, O:
Bellvitge Univ Hosp, Nephrol Dept, Kidney Transplant Unit, Barcelona, Spain
Manonelles, A:
Bellvitge Univ Hosp, Nephrol Dept, Kidney Transplant Unit, Barcelona, Spain
Paul, J:
Hosp Miguel Servet, Nephrol Dept, Kidney Transplant Unit, Zaragoza, Spain
Seron, D:
Vall dHebron Univ Hosp, Nephrol Dept, Kidney Transplant Unit, Barcelona, Spain
Facundo, C:
Fundacio PuigVert, Kidney Transplant Unit, Nephrol Dept, Barcelona, Spain
Cruzado, JM:
IDIBELL, Bellvitge Biomed Res Inst, Expt Nephrol Lab, Lhospitalet De Llobregat, Spain
Bellvitge Univ Hosp, Nephrol Dept, Kidney Transplant Unit, Barcelona, Spain
Vernet, SG:
Bellvitge Univ Hosp, Nephrol Dept, Kidney Transplant Unit, Barcelona, Spain
Grinyo, JM:
IDIBELL, Bellvitge Biomed Res Inst, Expt Nephrol Lab, Lhospitalet De Llobregat, Spain
Bellvitge Univ Hosp, Nephrol Dept, Kidney Transplant Unit, Barcelona, Spain
Bestard, O:
IDIBELL, Bellvitge Biomed Res Inst, Expt Nephrol Lab, Lhospitalet De Llobregat, Spain
Bellvitge Univ Hosp, Nephrol Dept, Kidney Transplant Unit, Barcelona, Spain
Green Accepted
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