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KMID : 0338420200350020438
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Korean Journal of Internal Medicine
2020 Volume.35 No. 2 p.438 ~ p.448
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Diagnostic usefulness of the cytomegalovirus (CMV)-specific T cell-based assay for predicting CMV infection after kidney transplant
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Kim Tae-Eun
Lee Hyun-Jeong
Kim Sun-Mi
Jung Joo-Hee
Shin Sung
Kim Young-Hoon
Sung Heung-Sup
Chong Yong-Pil
Lee Sang-Oh
Choi Sang-Ho
Kim Yang-Soo
Woo Jun-Hee
Kim Sung-Han
Han Duck-Jong
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Abstract
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Background/Aims: We evaluated the usefulness in kidney transplant (KT) candidates of cytomegalovirus (CMV)-specific enzyme-linked immunospot (ELISPOT) assays for predicting the development of post-transplant CMV infections.
Methods: All adult recipients admitted for living-donor KT between March 2014 and March 2015 were prospectively enrolled except donor CMV-seropositive and recipient seronegative (D+/R?) recipients. All the enrolled patients underwent CMV-specific ELISPOT assays before transplant, and a researcher blinded to the results of these assays examined the patients for CMV infection at least 6 months post-transplant.
Results: Of 133 KT recipients, 44 (33%) developed CMV infections. When we used the cut-off determined by receiver operator characteristic curve, 16 of the 34 patients (47%) with negative pp65-specific ELISPOT results (< 11 spots/200,000 cells) developed CMV infections, whereas 28 of the 99 patients (39%) with positive pp65-specific ELISPOT results at baseline (≥ 11 spots/200,000 cells) developed CMV infections after KT (p = 0.02). Based on the multivariable Cox regression model, negative pp65-specific ELISPOT assay results was an independent risk factor for CMV infection (adjusted hazard ratio [AHR], 1.87; 95% confidence interval [CI], 1.01 to 3.46; p = 0.047) as well as age (AHR, 1.05; 95% CI, 1.01 to 1.08; p = 0.007).
Conclusions: Pre-transplant CMV-specific ELISPOT assay appears to predict the development of CMV infections after KT in recipients at moderate risk such as CMV-seropositive recipients (Clinical Trial Registration Number NCT 02025335).
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KEYWORD
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Cytomegalovirus, T cell response, Enzyme-linked immunospot assay, Interferon-gamma release tests, Kidney transplantation
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