A recently published multicenter study led by Dr. Mario Fernández-Ruiz and Prof. José María Aguado, from the University Hospital “12 de Octubre” (Madrid), has confirmed the usefulness of a immune-based monitoring strategy to predict the risk of potentially severe opportunistic infections due to the reactivation of cytomegalovirus (CMV) in patients undergoing kidney transplantation. The study was carried out between March 2013 and December 2015 at four Spanish transplant centers within the REIPI network and involved 124 CMV-seropositive patients, in which CMV-specific CD4+ and CD8+ T-cells were assessed at periodic intervals during the first year after transplantation. Patients with sufficient counts of CMV-specific CD8+ T-cells at baseline had lower risk of developing any CMV infection thereafter, whereas those with sufficient number of baseline CMV-specific CD4+ T-cells also had lower risk of CMV disease (i.e., infection accompanied by attributable symptoms or organ dysfunction). Analogously, patients with protective counts of CMV-specific CD8+ or CD4+ T-cell measured at day 15 after transplantation were at significantly lower risk of suffering CMV infection throughout the first post-transplant year. These results offer an opportunity to accurately stratify the risk of post-transplant CMV infection and would allow for tailoring an individualized approach directed at patients most likely to benefit from antiviral prophylaxis.
Resumen en español:
Un estudio recientemente publicado, realizado en 4 centros españoles agrupados en la red REIPI entre Marzo de 2013 y Diciembre de 2015 y liderado por los Dres. Mario Fernández-Ruiz y José María Aguado del Hospital Universitario “12 de Octubre”, ha permitido confirmar que la monitorización a intervalos periódicos de la situación inmunitaria de pacientes sometidos a un trasplante renal es útil para predecir el riesgo de infecciones oportunistas por citomegalovirus (CMV). De este modo, y en función del recuento de linfocitos T CD4+ o CD8+ específicos frente a CMV en la evaluación basal o al cabo de 15 días del trasplante, se podría individualizar el riesgo de cada paciente y ajustar “a medida” la estrategia de prevención más apropiada en cada caso.
Artículo original: Fernández-Ruiz M, Giménez E, Vinuesa V, Ruiz-Merlo T, Parra P, Amat P, Montejo M, Paez-Vega A, Cantisán S, Torre-Cisneros J, Fortún J, Andrés A, San Juan R, López-Medrano F, Navarro D, Aguado JM; Group for Study of Infection in Transplantation of the Spanish Society of Infectious Diseases and Clinical Microbiology (GESITRA-SEIMC) and the Spanish Network for Research in Infectious Diseases (REIPI). Regular monitoring of cytomegalovirus (CMV)-specific cell-mediated immunity in intermediate-risk kidney transplant recipients: predictive value of the immediate post-transplant assessment. Clin Microbiol Infect. 2018 May 25. pii: S1198-743X(18)30441-5. doi: 10.1016/j.cmi.2018.05.010.