Monitoring Cytomegalovirus T-Cell Immunity in Small Bowel/Multivisceral Transplant Recipients

• Published in: Transplantation proceedings Vol. 42; no. 1; pp. 69 - 73
• Main Authors: Chiereghin, A, Gabrielli, L, Zanfi, C, Petrisli, E, Lauro, A, Piccirilli, G, Baccolini, F, Dazzi, A, Cescon, M, Morelli, M.C, Pinna, A.D, Landini, M.P, Lazzarotto, T
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Inc 2010; Elsevier
• Subjects: Adult; Alemtuzumab; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized; Antibodies, Neoplasm - therapeutic use; Antiviral Agents - therapeutic use; Biological and medical sciences; Cytomegalovirus - immunology; Cytomegalovirus Infections - immunology; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Ganciclovir - therapeutic use; Humans; Immunity, Cellular; Immunoglobulins - therapeutic use; Immunosuppressive Agents - therapeutic use; Infectious diseases; Intestine, Small - transplantation; Male; Medical sciences; Monitoring, Immunologic - methods; Postoperative Complications - immunology; Postoperative Complications - virology; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; T-Lymphocytes - immunology; Tacrolimus - therapeutic use; Tissue, organ and graft immunology; Viral diseases; Viscera - transplantation; Human; Opportunistic infection; Digestive system; Herpesviridae; Recipient; Transplantation; Homotransplantation; Betaherpesvirinae; Immunity; Small intestine; Human cytomegalovirus; Infection; Virus; Medicine; Treatment; Surveillance; Surgery; Viral disease; T-Lymphocyte; Graft; Monitoring
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2009.12.030

Abstract Background Cytomegalovirus (CMV) is a major cause of graft failure and posttransplantation mortality in intestinal/multivisceral transplantation. CMV infection exhibits a wide range of clinical manifestations from asymptomatic infection to severe CMV disease. Study's Purpose The purposes of this study were to assess the utility of measuring CMV-specific cellular immunity in bowel/multivisceral transplant recipients and to provide additional information on the risk of infection and development of CMV disease. Methods We studied 10 bowel/multivisceral transplant recipients to investigate the kinetics of CMV infection using real-time polymerase chain reaction (on blood and biopsy tissue samples) and CMV-specific T-cell reconstitution by Enzyme-linked ImmunoSPOT Assay (ELISPOT) that enumerates Interferon-γ–secreting CMV-specific T cells upon in vitro stimulation with viral antigens (pp65 and IE-1). Results All patients were seropositive for CMV. According to the pattern of T-cell reconstitution occurring either within the first month after transplantation or later, patients were classified as early (n = 7) or late responders (n = 3). Clinically, early responder patients (3/7; 43%) experienced asymptomatic or mild CMV infections, whereas all late responders (3/3; 100%) developed moderate or severe CMV disease. A reduction in mean and peak CMV viral load was observed in early responders, whereas the onset time of infection did not differ significantly between early and late CMV responders. Conclusions A good and early reconstitution of CMV-specific T-cell immune responses after transplantation is a critical determinant in controlling CMV infections. Simultaneous monitoring of CMV infection and CMV-specific T-cell immunity predicts T-cell–mediated control of CMV infection.