Real World Utilization of Protocolized T-Cell Immunity Panel Screening in Cytomegalovirus Seropositive Kidney...

Recently updated guidelines suggest monthly cytomegalovirus (CMV) cell-mediated immunity (CMI) testing in seropositive (R+) kidney transplant recipients to stratify posttransplant CMV risk and guide prophylaxis. UW Health has protocolized T-cell immunity panel (TCIP) testing since 2023. The purpose was to assess real-world implementation of TCIP testing and the feasibility of this approach.

This retrospective cohort study included adult R+ renal transplant (RTX) recipients transplanted March 1, 2023, to April 9, 2025, received lymphocyte depleting induction and completed TCIP testing at 3 months posttransplant.

Here, 234 patients were eligible for protocolized TCIP testing during the study period, with 160 patients obtaining a TCIP (68.4%). Mean time to TCIP draw was 94 ± 15.6 days post-RTX. Of those who obtained TCIP, 75 had positive, 57 negative, and 28 with indeterminate results. Significantly more patients with indeterminate TCIP received alemtuzumab induction (8.0% vs. 8.8%vs. 89.3%, p < 0.0001). Positive TCIP facilitated significantly shorter prophylaxis duration (153.8 vs. 172.2 vs. 180.1 days, p = 0.003). WBC were significantly lower among patients with an indeterminate TCIP (6.3 vs. 6.1 vs. 4.4 × 10³ cells/mm³, p = 0.0006). Patients with indeterminate TCIP were more likely to have ALC ≤ 400 cells/µL (32.0% vs. 33.3% vs. 89.3%, p < 0.0001). Incidence of post-prophylaxis CMV infection was comparable.

In this study, implementing protocolized TCIP testing at 3 months posttransplant in R+ kidney transplant recipients was feasible, with the main limitation being lab related draw-time considerations. Based on our center specific experience, stratification based on patient-specific factors should be considered before widespread implementation to optimize evaluable results given cost burden associated with testing.