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.

IF 2.6 4区医学 Q3 IMMUNOLOGY

Transplant Infectious Disease Pub Date : 2024-10-01 Epub Date: 2023-11-21 DOI:10.1111/tid.14198

Sílvia Vidal Campos, Lisete Ribeiro Teixeira, Maristela Pinheiro Freire, Ana Carolina Mamana, Clarisse Martins Machado

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引用次数: 0

Abstract

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.

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在中间相遇:细胞介导免疫试验能否成为肺移植后巨细胞病毒预防的理想答案?间歇性抗病毒预防的单中心观察性研究。

背景:巨细胞病毒(CMV)可引起肺移植(LTx)后的组织侵袭性疾病和间接影响，如急性排斥反应发作和慢性同种异体肺功能障碍。监测LTx术后CMV特异性细胞免疫恢复(CMV- cir)可以个体化CMV风险并建立更好的抗病毒方法。本研究使用QuantiFERON-CMV测定法(Qiagen Group)评估LTx后第一年CMV-CIR的动态。方法:前瞻性观察队列研究纳入2015年12月至2016年12月的肺移植受者。对cmv血清阳性受体(R+)给予静脉注射更昔洛韦5 mg/kg/天、每周3天、连续3个月的抗病毒预防，只有cmv血清阳性供者和阴性受体(D+/R-)接受6个月的更昔洛韦和缬更昔洛韦预防，前3个月隔天服用，然后再服用缬更昔洛韦3个月。在监测支气管镜检查的同一时间点测量QuantiFERON-CMV。CMV感染被定义为检测到任何dna血症和CMV疾病，经活检证实或抗原血症pp65高于10细胞/30万中性粒细胞。结果:纳入38例患者。在ltx后45、90和365天，分别有60%、72%和81%的QuantiFERON-CMV出现反应。11例(28.9%)出现巨细胞病毒病，27例dna血症/巨细胞病毒感染。反应性试验仅能在LTx后90天预测巨细胞病毒疾病(p = 0.027)，但不能预测dna血症/巨细胞病毒感染(p = 0.148)。对于D+/R-患者(13.2%)，每日预防仍然是未达到反应性QuantiFERON-CMV的独立相关因素(调整OR为0.27,95%CI为0.12 -)。60, p = .02)。结论:QuantiFERON-CMV可能是LTx术后cmv疾病风险分层和个体化抗病毒预防的另一种诊断工具。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplant Infectious Disease 医学-传染病学

CiteScore

5.30

自引率

7.70%

发文量

210

审稿时长

4-8 weeks

期刊介绍： Transplant Infectious Disease has been established as a forum for presenting the most current information on the prevention and treatment of infection complicating organ and bone marrow transplantation. The point of view of the journal is that infection and allograft rejection (or graft-versus-host disease) are closely intertwined, and that advances in one area will have immediate consequences on the other. The interaction of the transplant recipient with potential microbial invaders, the impact of immunosuppressive strategies on this interaction, and the effects of cytokines, growth factors, and chemokines liberated during the course of infections, rejection, or graft-versus-host disease are central to the interests and mission of this journal. Transplant Infectious Disease is aimed at disseminating the latest information relevant to the infectious disease complications of transplantation to clinicians and scientists involved in bone marrow, kidney, liver, heart, lung, intestinal, and pancreatic transplantation. The infectious disease consequences and concerns regarding innovative transplant strategies, from novel immunosuppressive agents to xenotransplantation, are very much a concern of this journal. In addition, this journal feels a particular responsibility to inform primary care practitioners in the community, who increasingly are sharing the responsibility for the care of these patients, of the special considerations regarding the prevention and treatment of infection in transplant recipients. As exemplified by the international editorial board, articles are sought throughout the world that address both general issues and those of a more restricted geographic import.