Meet in the middle: Could cell mediated-immunity assays be the answer for ideal Cytomegalovirus prophylaxis after lung transplantation? Observational study from a single center with intermittent antiviral prophylaxis.

Autor: Campos SV; Pulmonary Division, Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil., Teixeira LR; Pulmonary Division, Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil., Freire MP; Infection Control Team, Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil., Mamana AC; Virology Laboratory (LIM 52 HCFMUSP), Institute of Tropical Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil., Machado CM; Virology Laboratory (LIM 52 HCFMUSP), Institute of Tropical Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil.
Jazyk: angličtina
Zdroj: Transplant infectious disease : an official journal of the Transplantation Society [Transpl Infect Dis] 2024 Oct; Vol. 26 (5), pp. e14198. Date of Electronic Publication: 2023 Nov 21.
DOI: 10.1111/tid.14198
Abstrakt: Background: Cytomegalovirus (CMV) can cause tissue-invasive disease and indirect effects after lung transplantation (LTx) such as acute rejection episodes and chronic lung allograft dysfunction. Monitoring CMV-specific cell immune recovery (CMV-CIR) after LTx can individualize CMV risks and establish better antiviral approach. This study evaluated the dynamics of CMV-CIR, using QuantiFERON-CMV assay (Qiagen Group), in the first year after LTx.
Methods: Prospective observational cohort study included lung transplant recipients from December/2015 to December/2016. Universal antiviral prophylaxis with intravenous ganciclovir 5 mg/kg/day 3 days/week for 3 months was given for CMV-seropositive recipients (R+) and only CMV-seropositive donor and negative recipient (D+/R-) received a 6-month-prophylaxis with ganciclovir and valganciclovir, on alternate days, in the first 3 months and then, 3 more months of valganciclovir. QuantiFERON-CMV was measured at the same time points of surveillance bronchoscopies. CMV infection was defined as any DNAemia detected and CMV disease with proven biopsy or antigenemia pp65 above 10 cells/300.000 neutrophils.
Results: Thirty-eight patients were included. On days 45, 90, and 365 days post-LTx, 60%, 72%, and 81% QuantiFERON-CMV were reactive, respectively. Eleven patients (28.9%) presented CMV-disease and 27 DNAemia/CMV infections. Reactive tests were able to predict CMV disease only at 90 days after LTx (p = .027) but failed on DNAemia/CMV infection (p = .148). Daily prophylaxis, for D+/R- patients (13.2%), remained as an independently associated factor for not achieving reactive QuantiFERON-CMV (adjusted OR .27, 95%CI .12-.60, p = .02).
Conclusion: QuantiFERON-CMV may be another diagnostic tool to help stratify CMV-disease risk and individualized antiviral prophylaxis after LTx.
(© 2023 Wiley Periodicals LLC.)
Databáze: MEDLINE
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