Humoral Immunity Profiles to Identify CMV-seropositive Heart Recipients at Risk of CMV Disease: A Prospective Multicenter Study

Sarmiento, E.; Jaramillo, María; Navarro, José Francisco; Rodrı́guez-Molina, J.; Fernàndez-Yáñez, J.; Palomo, Jesús; Gómez-Sánchez, Miguel Ángel; Crespo-Leiro, María G.; Paniagua, Manuel; Almenar, Luís; Cebrian, Monica; Segovia, J.; Gómez, M. C.; Rábago, Gregorio; Lévy, Bernard; Mirabet, Sònia; López, Jorge López; Garcı́a-Guereta, Luis; Carbone, Javier

doi:10.1016/j.healun.2014.01.082

Cited by 2 publications

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“… 48 Using a slightly higher cutoff point of 600 mg/dL at day 30, the same group recently confirmed in a larger population in a multicenter study (n = 202) of CMV-seropositive heart transplant recipients that low IgG is an independent risk factor for CMV disease (adjusted odds ratio, 11.9; P = 0.02). 49 Low levels of IgG at day 7 posttransplant are also predictive of infection of any type, 50 , 51 consistent with previously published data. 51 Of note, the combination of low levels of IgG coupled with low complement C3 at month 1 confers a particularly high increase in the risk for CMV disease by month 6.…”

Section: The Immune Response To CMV In Transplant Recipientssupporting

confidence: 89%

“… 51 Of note, the combination of low levels of IgG coupled with low complement C3 at month 1 confers a particularly high increase in the risk for CMV disease by month 6. 49 …”

Section: The Immune Response To CMV In Transplant Recipientsmentioning

confidence: 99%

“…A reduction in CMV-specific antibody titers has also been documented during the first month after heart transplantation, regardless of CMV infection status. 39 , 48 , 49 In a prospective analysis of 202 CMV-seropositive heart transplant patients at a single center, the mean anti-CMV titer decreased from 20 419 to 14 235 titer dilutions by day 30 in patients who developed CMV disease ( P = 0.044) and from 22 232 to 18 247 titer dilutions ( P < 0.001) in patients without CMV disease. 49 Low anti-CMV titer at month 1 increases the risk of CMV infection after heart transplantation (Figure 3 ).…”

Section: The Immune Response To CMV In Transplant Recipientsmentioning

confidence: 99%

“… 39 , 48 , 49 In a prospective analysis of 202 CMV-seropositive heart transplant patients at a single center, the mean anti-CMV titer decreased from 20 419 to 14 235 titer dilutions by day 30 in patients who developed CMV disease ( P = 0.044) and from 22 232 to 18 247 titer dilutions ( P < 0.001) in patients without CMV disease. 49 Low anti-CMV titer at month 1 increases the risk of CMV infection after heart transplantation (Figure 3 ). In a multivariate analysis of prospectively recorded data from 71 heart transplant patients (with CMVIG administered only in high-risk cases), 10 patients developed CMV disease.…”

Section: The Immune Response To CMV In Transplant Recipientsmentioning

confidence: 99%

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The Immunology of Posttransplant CMV Infection

Carbone

2016

Transplantation

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The immune response to cytomegalovirus (CMV) infection is highly complex, including humoral, cellular, innate, and adaptive immune responses. Detection of CMV by the innate immune system triggers production of type I IFNs and inflammatory cytokines which initiate cellular and humoral responses that are critical during the early viremic phase of CMV infection. Sustained control of CMV infection is largely accounted for by cellular immunity, involving various T-cell and B-cell subsets. In solid organ transplant patients, global suppression of innate and adaptive immunities by immunosuppressive agents limits immunological defense, including inhibition of natural killer cell activity with ongoing lowering of Ig levels and CMV-specific antibody titers. This is coupled with a short-term suppression of CMV-specific T cells, the extent and duration of which can predict risk of progression to CMV viremia. CMV immunoglobulin (CMVIG) preparations have the potential to exert immunomodulatory effects as well as providing passive immunization. Specific CMVIG antibodies and virus neutralization might be enhanced by modulation of dendritic cell activity and by a decrease in T-cell activation, effects which are of importance during the initial phase of infection. In summary, the role of CMVIG in reconstituting specific anti-CMV antibodies may be enhanced by some degree of modulation of the innate and adaptive immune responses, which could help to control some of the direct and indirect effects of CMV infection.

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Section: The Immune Response To CMV In Transplant Recipientssupporting

confidence: 89%

“… 51 Of note, the combination of low levels of IgG coupled with low complement C3 at month 1 confers a particularly high increase in the risk for CMV disease by month 6. 49 …”

Section: The Immune Response To CMV In Transplant Recipientsmentioning

confidence: 99%

Section: The Immune Response To CMV In Transplant Recipientsmentioning

confidence: 99%

Section: The Immune Response To CMV In Transplant Recipientsmentioning

confidence: 99%

See 2 more Smart Citations

The Immunology of Posttransplant CMV Infection

Carbone

2016

Transplantation

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“…We previously demonstrated that moderate hypogammaglobulinemia (HGG) (immunoglobulin G [IgG] <500 mg/dL) at 1 week after transplantation was a risk factor for severe infectious complications in heart recipients . In a multicenter study, we also showed that the presence of HGG in seropositive heart recipients is associated with an increased risk of specific infections, such as cytomegalovirus (CMV) infection . HGG has also been reported in recipients of other solid organs (e.g., lung, kidney, and liver), and a significant association with overall and specific infectious complications has been observed .…”

Section: Introductionmentioning

confidence: 99%