Real World Utilization of Protocolized T-Cell Immunity Panel Screening in Cytomegalovirus Seropositive Kidney Transplant Recipients.

IF 2.5 4区医学 Q3 IMMUNOLOGY

Transplant Infectious Disease Pub Date : 2026-07-21 DOI:10.1111/tid.70283

Hanna Kleiboeker, Cassilyn Streblow, Jillian Descourouez, Christopher Saddler, John Rice, Didier Mandelbrot, Jon Odorico, Margaret Jorgenson

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引用次数: 0

Abstract

Background: Recently updated guidelines suggest monthly cytomegalovirus (CMV) cell-mediated immunity (CMI) testing in seropositive (R+) kidney transplant recipients to stratify posttransplant CMV risk and guide prophylaxis. UW Health has protocolized T-cell immunity panel (TCIP) testing since 2023. The purpose was to assess real-world implementation of TCIP testing and the feasibility of this approach.

Methods: This retrospective cohort study included adult R+ renal transplant (RTX) recipients transplanted March 1, 2023, to April 9, 2025, received lymphocyte depleting induction and completed TCIP testing at 3 months posttransplant.

Results: Here, 234 patients were eligible for protocolized TCIP testing during the study period, with 160 patients obtaining a TCIP (68.4%). Mean time to TCIP draw was 94 ± 15.6 days post-RTX. Of those who obtained TCIP, 75 had positive, 57 negative, and 28 with indeterminate results. Significantly more patients with indeterminate TCIP received alemtuzumab induction (8.0% vs. 8.8%vs. 89.3%, p < 0.0001). Positive TCIP facilitated significantly shorter prophylaxis duration (153.8 vs. 172.2 vs. 180.1 days, p = 0.003). WBC were significantly lower among patients with an indeterminate TCIP (6.3 vs. 6.1 vs. 4.4 × 10³ cells/mm³, p = 0.0006). Patients with indeterminate TCIP were more likely to have ALC ≤ 400 cells/µL (32.0% vs. 33.3% vs. 89.3%, p < 0.0001). Incidence of post-prophylaxis CMV infection was comparable.

Conclusion: In this study, implementing protocolized TCIP testing at 3 months posttransplant in R+ kidney transplant recipients was feasible, with the main limitation being lab related draw-time considerations. Based on our center specific experience, stratification based on patient-specific factors should be considered before widespread implementation to optimize evaluable results given cost burden associated with testing.

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t细胞免疫筛选在巨细胞病毒血清阳性肾移植受者中的实际应用

背景：最近更新的指南建议对血清阳性（R+）肾移植受者每月进行巨细胞病毒（CMV）细胞介导免疫（CMI）检测，以分层移植后巨细胞病毒风险并指导预防。自2023年以来，UW Health已将t细胞免疫小组（TCIP）测试纳入协议。目的是评估TCIP测试的实际实施情况以及该方法的可行性。方法：本回顾性队列研究纳入了2023年3月1日至2025年4月9日移植的成人R+肾移植（RTX）受者，接受淋巴细胞消耗诱导，并在移植后3个月完成TCIP检测。结果：在研究期间，234例患者符合协议TCIP检测条件，其中160例患者获得TCIP（68.4%）。rtx后平均TCIP提取时间为94±15.6天。在获得TCIP的患者中，75例阳性，57例阴性，28例结果不确定。明显更多的不确定TCIP患者接受了阿仑单抗诱导（8.0%比8.8%）。89.3%, p < 0.0001)。TCIP阳性显著缩短了预防持续时间（153.8天vs. 172.2天vs. 180.1天，p = 0.003）。TCIP不确定患者的WBC显著降低（6.3 vs 6.1 vs 4.4 × 103细胞/mm3， p = 0.0006）。不确定TCIP患者ALC≤400 cells/µL的可能性更大（32.0% vs. 33.3% vs. 89.3%, p < 0.0001）。预防后巨细胞病毒感染的发生率具有可比性。结论：在本研究中，在移植后3个月对R+肾移植受者实施规范的TCIP检测是可行的，主要限制是与实验室相关的耗时考虑。根据我们中心的具体经验，在广泛实施之前应考虑基于患者特定因素的分层，以优化与检测相关的成本负担的可评估结果。

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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.