Evaluation of CMV-specific cellular immune response by EliSPOT assay in kidney transplant patients
Cristina Costa1, Cinzia Balloco1, Francesca Sidoti1
1Microbiology and Virology Unit, Laboratory of Virology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy.
Insights
Cytomegalovirus (CMV) immunological monitoring using EliSPOT assay in kidney transplant recipients identifies responders at lower risk of infection. This data aids clinical decisions alongside viral load monitoring.
Area of Science:
- Transplant Immunology
- Virology
- Cellular Immunity
Background:
- Routine immunological monitoring for Cytomegalovirus (CMV) in transplant patients is underutilized.
- Assessing CMV-specific cellular response is crucial for managing post-transplant complications.
Purpose of the Study:
- To evaluate CMV-specific cellular response in kidney transplant recipients.
- To correlate immune response with CMV infection/reactivation, demographic, and clinical factors.
Main Methods:
- EliSPOT assay used to assess CMV-specific T-cell response in 328 kidney transplant recipients.
- Prospective monitoring for 201 patients and single determination for 127 patients.
- Evaluation of clinical data including CMV-DNAemia, serostatus, antiviral use, and immunosuppression.
Main Results:
- 66.5% of patients were CMV-responders by EliSPOT.
- Responders showed significantly lower CMV infection rates (73.4% vs 55.5%) and longer CMV-free periods.
- Non-responders had higher CMV-DNAemia (>10(5) copies/mL) and were associated with CMV-seronegativity, antiviral prophylaxis, and basiliximab induction.
Conclusions:
- CMV immunological data, assessed via EliSPOT, is valuable for clinical decision-making in kidney transplant recipients.
- Integrating immunological monitoring with virological monitoring can improve patient management.
- Identifying CMV-responders can predict a lower risk of viral infection and reactivation.
Background:
Immunological monitoring for CMV can be useful in transplant patients; however, few centers perform it on a routine basis.
Objectives:
In this study, CMV-specific cellular response was evaluated in a population of kidney transplant recipients and related to viral infection/reactivation and other demographic and clinical features.
Study Design:
Three hundred and twenty-eight patients were studied by EliSPOT assay: 201 prospectively monitored in the first year posttransplantation, 127 with a single determination at >1 year. Clinical features, including occurrence of CMV-DNAemia, CMV serostatus, anti-viral strategies and immunosuppressive protocols, were evaluated.
Results:
Overall, 66.5% of patients were CMV-responders at EliSPOT assay. No episode of infection occurred at follow-up (mean 24.5 months) in 73.4% responders versus 55.5% non-responders (p<0.005); CMV-free period was significantly longer in responders (p<0.001). Although no significant difference of peak viral load was found, prevalence of CMV-DNAemia values >10(5)copies/mL was significantly higher in non-responders versus responders (8.2% and 2.3%, p<0.05). Non-responder status was significantly associated to CMV-seronegativity (p<0.0001), anti-viral prophylaxis use (p<0.0001), and immunosuppression induction with basiliximab (p<0.005). No significant association was found for other clinical features and immunosuppressive protocols.
Conclusions:
Immunological data for CMV could be used in the clinical evaluation and decision-making process, in combination with virological monitoring, in kidney transplant recipients.
Related Concept Videos
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01:28Kidney Transplant I: Introduction