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- Title
Tailoring cytomegalovirus prophylaxis based on T cell immunity panel assessment in kidney transplant patients at high risk of cytomegalovirus.
- Authors
Servais, Abigail M.; McMullen, John S.; Bowen, Riley; Kleiboeker, Steven B.; Ulloa, Isabelle; Duncan, Kara; Miles, Clifford D
- Abstract
Background: Valganciclovir prophylaxis against cytomegalovirus (CMV) is recommended for solid organ transplant recipients, but is associated with drawbacks, including expense and leukopenia. Our center adopted a strategy of serial assessment with a CMV‐specific T cell immunity panel (CMV‐TCIP) and cessation of valganciclovir prophylaxis upon demonstration of adequate CD4+ responses in kidney transplant patients at high risk of CMV disease. Methods: We retrospectively reviewed adult recipients of a kidney or pancreas transplant between August 2019 and July 2021 undergoing serial CMV‐TCIP monitoring. Included patients were considered high risk for CMV, defined by donor positive (D+)/recipient negative (R−) CMV IgG serostatus, or recipient positive (R+) patients who received induction with a lymphocyte‐depleting agent. Prophylaxis was discontinued after a patient's first CMV‐specific CD4+ T cell value of ≥0.20%. Risk of clinically significant CMV infection (csCMVi) in those who underwent early discontinuation of CMV prophylaxis and predictors of CMV T cell immunity were analyzed. Results: Of 54 included patients, 22 stopped prophylaxis early due to CMV‐specific CD4+ T cell immunity at a median of 4.7 (IQR: 3.8–5.4) months after transplant. No instances of csCMVi were observed in the 22 patients who had prophylaxis discontinued early, of whom 19/22 were CMV R+ and 3/22 were CMV D+/R−. Donor/recipient CMV serostatus was predictive of immunity (p <.001). Conclusion: Early discontinuation of valganciclovir prophylaxis in patients with CMV CD4+ T cellular immunity appears safe and potentially beneficial in this preliminary series, especially in R+ patients. Further study is warranted, given that truncated prophylaxis may yield patient‐level benefits.
- Subjects
PANCREAS transplantation; CYTOMEGALOVIRUS diseases; CELLULAR immunity; T cells; TRANSPLANTATION of organs, tissues, etc.; KIDNEY transplantation
- Publication
Transplant Infectious Disease, 2024, Vol 26, Issue 4, p1
- ISSN
1398-2273
- Publication type
Article
- DOI
10.1111/tid.14291