Predictive Value of Pretransplant Cytomegalovirus-Specific Cellular Immunity for Posttransplant CMV Infection in Liver Transplant Recipients Under Antiviral Prophylaxis.
Elif Seren Tanriverdi, Yusuf Yakupogullari, Yasar Bayindir, Sami Akbulut, Sibel Altunisik Toplu, Harika Gozde Gozukara Bag, Burak Isik, Baris Otlu, Sezai Yilmaz
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Abstract
Background: Existing data suggest that cytomegalovirus (CMV)-specific cell-mediated immunity (CMV-CMI) in solid organ recipients may predict post-transplant CMV infection, but the available information is still limited, and needs to be validated for larger patient populations under certain circumstances. This study aimed to determine whether CMV-CMI could predict post-transplant CMV infection in liver transplant recipients (LTRs) receiving antiviral prophylaxis (AVP).
Methods: A total of 1769 LTRs at the Inonu University Liver Transplantation Institute were retrospectively analyzed. CMV-CMI in a total of 334 patients (> 91% were CMV donor [D] positive/recipient [R] positive) who received AVP were analyzed using the CMV-Interferon (CMV-QF; QuantiFERON-CMV, Qiagen, Germany) assay within the week before transplantation. Patients were divided into two groups: group 1 (positive; n = 171, 51.2%) and group 2 (negative; n = 163, 48.8%). Patient variables were analyzed statistically.
Results: A total of 124 LTRs developed CMV infection. Patients' pre-transplant characteristics did not differ significantly by their CMV-CMI result. A significantly lower percentage of LTRs with CMV-CMI positive developed infection than those with negatives (7.6% vs 68.1%, P < .001). All CMV-CMI positive patients fully recovered with antiviral treatment but only 76.6% of LTRs with negative CMV-CMI (P = .032). Logistic regression analysis showed that a negative CMV-CMI was associated with a 26 times increased risk of CMV infection compared to those with positive CMV-CMI (odds ratio [OR] = 25.9, P < .001). Female recipients developed CMV infection earlier after cessation of AVP than male recipients (median = 128 vs 144 days, P = .038).
Conclusions: The pre-transplant status of CMV-CMI may be a strong indicator of post-transplant CMV infection for LTRs receiving AVP. Therefore, further consideration should be made for the LTRs with negative CMV-CMI.
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