Cytomegalovirus Infection After Solid Organ Transplantation: How I Use Cell-Mediated Immune Assays for Management.

IF 3.8 3区 医学 Q2 VIROLOGY
Viruses-Basel Pub Date : 2024-11-15 DOI:10.3390/v16111781
Raymund R Razonable
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Abstract

Introduction: The pathogenesis and outcome of cytomegalovirus (CMV) infection after solid organ transplantation (SOT) reflects the interplay between viral replication and CMV-specific immunity. Despite advances in its diagnosis and treatment, CMV continues to cause significant morbidity after SOT. Since CMV is an opportunistic pathogen that occurs as a result of impaired pathogen-specific immunity, laboratory assays that measure CMV-specific immune responses may be useful in assisting clinicians in its management.

Methods and results: The author summarizes the evolving and emerging data on the clinical utility of assays that quantify cell-mediated immune responses to CMV in SOT recipients. The majority of publications are observational studies that demonstrate that a lack or deficiency in CMV-specific cell-mediated immunity is correlated with a heightened risk of primary, reactivation, or recurrent CMV after transplantation. A few prospective interventional studies have utilized CMV-specific cell-mediated immune assays in guiding the duration of antiviral prophylaxis among CMV-seropositive SOT recipients. Likewise, CMV-specific cell-mediated immunity assays have been suggested to inform the need for secondary antiviral prophylaxis and immunologic optimization to prevent CMV relapse after treatment.

Conclusions: CMV-specific cell-mediated immune assays are emerging to assist transplant clinicians in predicting a patient's risk of CMV after transplantation, and these assays have been utilized to individualize the approach to CMV prevention and treatment. The author suggests the conduct of more interventional studies to further solidify the role of CMV-specific cell-mediated immune assays in routine clinical practice.

实体器官移植后的巨细胞病毒感染:我如何使用细胞介导的免疫测定进行管理。
导言:实体器官移植(SOT)后巨细胞病毒(CMV)感染的发病机制和结果反映了病毒复制和 CMV 特异性免疫之间的相互作用。尽管在诊断和治疗方面取得了进展,但 CMV 仍会在 SOT 后导致严重的发病率。由于 CMV 是一种机会性病原体,是病原体特异性免疫受损的结果,因此测量 CMV 特异性免疫反应的实验室检测方法可能有助于临床医生对其进行管理:作者总结了有关量化SOT受者对CMV的细胞介导免疫反应的检测方法的临床实用性的不断发展和新出现的数据。大多数出版物都是观察性研究,这些研究表明,CMV 特异性细胞介导免疫的缺乏或不足与移植后原发性、再激活或复发性 CMV 风险的增加相关。一些前瞻性干预研究利用 CMV 特异性细胞介导免疫测定来指导 CMV 血清阳性的 SOT 受者进行抗病毒预防的持续时间。同样,有人建议利用 CMV 特异性细胞介导免疫测定来确定是否需要进行二次抗病毒预防和免疫学优化,以防止 CMV 在治疗后复发:结论:CMV 特异性细胞介导免疫测定方法的出现有助于移植临床医生预测患者移植后感染 CMV 的风险,这些方法已被用于 CMV 预防和治疗的个体化。作者建议开展更多干预性研究,进一步巩固 CMV 特异性细胞介导免疫测定在常规临床实践中的作用。
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来源期刊
Viruses-Basel
Viruses-Basel VIROLOGY-
CiteScore
7.30
自引率
12.80%
发文量
2445
审稿时长
1 months
期刊介绍: Viruses (ISSN 1999-4915) is an open access journal which provides an advanced forum for studies of viruses. It publishes reviews, regular research papers, communications, conference reports and short notes. Our aim is to encourage scientists to publish their experimental and theoretical results in as much detail as possible. There is no restriction on the length of the papers. The full experimental details must be provided so that the results can be reproduced. We also encourage the publication of timely reviews and commentaries on topics of interest to the virology community and feature highlights from the virology literature in the ''News and Views'' section. Electronic files or software regarding the full details of the calculation and experimental procedure, if unable to be published in a normal way, can be deposited as supplementary material.
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