Monitoring of CMV-Specific Cell-Mediated Immunity in Kidney Transplant Recipients With a High Risk of CMV Disease (D+/R−): A Case Series

Andreani, Marine; Albano, Laetitia; Benzaken, Sylvia; Cassuto, Élisabeth; Jeribi, Ahmed; Caramella, Anne; Giordanengo, Valérie; Bernard, Ghislaine; Esnault, Vincent; Seitz-Polski, Barbara

doi:10.1016/j.transproceed.2019.11.002

Cited by 9 publications

(5 citation statements)

References 30 publications

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“…Serial monitoring of CMV CMI in the right clinical setting may guide clinical management in post-transplant care. 27,28 We observed a high incidence of asymptomatic CMV reactivation upon discontinuation of prophylaxis, and this alludes to the possibility that the current immunosuppression dosing regimen (based on a protocol-driven approach) may be excessive for our local Asian population. The immunological and metabolic risk profile in our patients may be inherently different from the Caucasian population for which current immunosuppression dosing regimens are derived.…”

Section: Discussionmentioning

confidence: 95%

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A single-centre observational study comparing the impact of different cytomegalovirus prophylaxis strategies on cytomegalovirus infections in kidney transplant recipients

Tan

Chung

et al. 2020

Proceedings of Singapore Healthcare

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Background/objective: Prevention of cytomegalovirus (CMV) infection is an important component of post kidney transplant care. We aimed to evaluate the impact of two different CMV prophylaxis protocols on the epidemiology and outcomes of CMV infections at our centre. Methods: This is a single-centre retrospective before/after observational study. Kidney transplant recipients who received Protocol 1, a valacyclovir- or valganciclovir-based regimen prescribed for one to three months based on the CMV risk status between 2004 and 2008, were compared to those who received Protocol 2, a valganciclovir-based regimen prescribed for three months and six months for those at moderate and high risk, respectively, between 2010 and 2014. The impact of different prophylaxis regimens on the incidence of CMV infections, disease, recurrent infections and onset of CMV infection at 24 months were reviewed. Results: There were 192 patients included; 106 patients received Protocol 1, 86 received Protocol 2. At 24 months, the incidence of CMV infection was 53.8% and 55.8% in Protocols 1 and 2, respectively ( p=0.884). The incidence rates of CMV disease and recurrent CMV infections were higher in Protocol 1, but this was not statistically significant. The median time to first CMV infection was significantly shorter in patients who received Protocol 1: 132 days (interquartile range (IQR) 125–139 days) versus 185 days (IQR 178–192 days), p=0.001. Both prophylaxis protocols were well tolerated. Conclusion: The incidence of CMV infection was similar in both protocols. Where valganciclovir is not available, valacyclovir may be considered over no prophylaxis. Post-prophylaxis CMV infections are not uncommon, and vigilance for it should be advocated.

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Section: Discussionmentioning

confidence: 95%

“…Serial monitoring of CMV CMI in the right clinical setting may guide clinical management in post-transplant care. 27,28…”

Section: Discussionmentioning

confidence: 99%

A single-centre observational study comparing the impact of different cytomegalovirus prophylaxis strategies on cytomegalovirus infections in kidney transplant recipients

Tan

Chung

et al. 2020

Proceedings of Singapore Healthcare

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“…It has been demonstrated across different SOT groups that patients without CMV-CMI at the end of prophylaxis have a consistent higher risk of late-onset CMV events and posttreatment relapse [19]. Moreover, CMV-CMI may predict evolution of asymptomatic viremia following prophylaxis discontinuation to spontaneous viral clearance (when positive) or the development of a CMV disease (when negative) [20].…”

Section: Cytomegalovirus Specific Immunitymentioning

confidence: 99%

Recent advances in cytomegalovirus infection management in solid organ transplant recipients

Grossi,

Peghin

2024

Current Opinion in Organ Transplantation

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Purpose of review Human cytomegalovirus (CMV) continues to be the most important infectious complication following solid organ transplantation (SOT). Recent findings Universal prophylaxis and preemptive therapy are the most adopted strategies for prevention of CMV disease globally. Prophylaxis with valganciclovir is the most widely used approach to CMV prevention, however leukopenia and late onset CMV disease after discontinuation of prophylaxis requires new strategies to prevent this complication. The use of assays detecting CMV-specific T cell-mediated immunity may individualize the duration of antiviral prophylaxis after transplantation. Letermovir has been recently approved for prophylaxis in kidney transplant recipients. CMV-RNAemia used together with CMV-DNAemia in the viral surveillance of CMV infection provides accurate information on viral load kinetics, mostly in patients receiving letermovir prophylaxis/therapy. The development of refractory and resistant CMV infection remains a major challenge and a new treatment with maribavir is currently available. In the present paper we will review the most recent advances in prevention and treatment of CMV diseases in SOT recipients. Summary Recent findings, summarized in the present paper, may be useful to optimize prevention and treatment of CMV infection in SOT.

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“…The latter finding is not unexpected as the presentation to the CD8 + T-cells of the viral epitopes contained in the "antigen tube" of the assay is restricted through some HLA class I alleles [86,87]. Finally, some studies have been conducted to investigate the usefulness of post-transplant CMV-CMI monitoring among intermediate-risk recipients preemptively managed to predict protection against the development of CMV infection or, once established, the capacity of spontaneous clearance of viremia [42,44,49,51,52,[61][62][63][64][65][66]. These results pointed to the predominance of CD8 + T-cells in the early response to primary infection-or re-infection in the D+/R+ constellation-and CD4 + T-cells in the long-term control of latent infection [42,44,61].…”

Section: Observational Data On the Clinical Application Of CMV Immune...mentioning

confidence: 99%

Cytomegalovirus Cell-Mediated Immunity: Ready for Routine Use?

Bestard,

Kaminski,

Couzi

et al. 2023

Transpl Int

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Utilizing assays that assess specific T-cell-mediated immunity against cytomegalovirus (CMV) holds the potential to enhance personalized strategies aimed at preventing and treating CMV in organ transplantation. This includes improved risk stratification during transplantation compared to relying solely on CMV serostatus, as well as determining the optimal duration of antiviral prophylaxis, deciding on antiviral therapy when asymptomatic replication occurs, and estimating the risk of recurrence. In this review, we initially provide an overlook of the current concepts into the immune control of CMV after transplantation. We then summarize the existent literature on the clinical experience of the use of immune monitoring in organ transplantation, with a particular interest on the outcomes of interventional trials. Current evidence indicates that cell-mediated immune assays are helpful in identifying patients at low risk for replication for whom preventive measures against CMV can be safely withheld. As more data accumulates from these and other clinical scenarios, it is foreseeable that these assays will likely become part of the routine clinical practice in organ transplantation.

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Monitoring of CMV-Specific Cell-Mediated Immunity in Kidney Transplant Recipients With a High Risk of CMV Disease (D+/R−): A Case Series

Cited by 9 publications

References 30 publications

A single-centre observational study comparing the impact of different cytomegalovirus prophylaxis strategies on cytomegalovirus infections in kidney transplant recipients

A single-centre observational study comparing the impact of different cytomegalovirus prophylaxis strategies on cytomegalovirus infections in kidney transplant recipients

Recent advances in cytomegalovirus infection management in solid organ transplant recipients

Cytomegalovirus Cell-Mediated Immunity: Ready for Routine Use?

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