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. 2018 Apr 16;18(1):179.
doi: 10.1186/s12879-018-3075-z.

Diagnostic utility of monitoring cytomegalovirus-specific immunity by QuantiFERON-cytomegalovirus assay in kidney transplant recipients

Dominika Deborska-Materkowska  1 , Agnieszka Perkowska-Ptasinska  2 , Anna Sadowska  2 , Jolanta Gozdowska  2 , Michał Ciszek  3 , Marta Serwanska-Swietek  4 , Piotr Domagala  4 , Dorota Miszewska-Szyszkowska  2 , Elzbieta Sitarek  2 , Agnieszka Jozwik  4 , Artur Kwiatkowski  4 , Magdalena Durlik  2
Affiliations

Diagnostic utility of monitoring cytomegalovirus-specific immunity by QuantiFERON-cytomegalovirus assay in kidney transplant recipients

Dominika Deborska-Materkowska et al. BMC Infect Dis. .

Abstract

Background: Despite universal prophylaxis, late cytomegalovirus (CMV) infection occurs in a high proportion of kidney transplant recipients. We evaluated whether a specific viral T-cell response allows for the better identification of recipients who are at high risk of CMV infection after prophylaxis withdrawal.

Methods: We conducted a prospective study in 19 pretransplant anti-CMV seronegative kidney graft recipients R- (18 from seropositive donors [D+] and one from a seronegative donor [D-]) and 67 seropositive recipients R(+) (59 from seropositive donors and eight from seronegative donors) who received antiviral prophylaxis with valganciclovir. The QuantiFERON-CMV (QF-CMV) assay was performed within the first and third months after transplantation. Blood samples were monitored for CMV DNAemia using a commercial quantitative nucleic acid amplification test (QNAT) that was calibrated to the World Health Organization International Standard.

Results: Twenty-one of the 86 patients (24%) developed CMV viremia after prophylaxis withdrawal within 12 months posttransplantation. In the CMV R(+) group, the QF-CMV assay yielded reactive results (QF-CMV[+]) in 51 of 67 patients (76%) compared with 7 of 19 patients (37%) in the CMV R(-) group (p = 0.001). In the CMV R(+) group, infection occurred in seven of 16 recipients (44%) who were QF-CMV(-) and eight of 51 recipients (16%) who were QF-CMV(+). In the CMV R(-) group, infection evolved in five of 12 recipients (42%) who were QF-CMV(-) and one of 7 recipients (14%) who were QF-CMV(+). No difference was found in the incidence of CMV infection stratified according to the QF-CMV results with regard to the recipients' pretransplant CMV IgG serology (p = 0.985). Cytomegalovirus infection occurred in 15 of 36 patients (42%) with hypogammaglobulinemia (HGG) 90 days posttransplantation compared with two of 34 patients (6%) without HGG (p = 0.0004). Cytomegalovirus infection occurred in seven of 13 patients (54%) with lymphocytopenia compared with 14 of 70 patients (20%) without lymphocytopenia (p = 0.015). The multivariate analysis revealed that the nonreactive QuantiFERON-CMV assay was an independent risk factor for postprophylaxis CMV infection.

Conclusions: In kidney transplant recipients who received posttransplantation prophylaxis, negative QF-CMV results better defined the risk of CMV infection than initial CMV IgG status after prophylaxis withdrawal. Hypogammaglobulinemia and lymphocytopenia were risk factors for CMV infection.

Keywords: Cytomegalovirus infection; Hypogammaglobulinemia; Kidney transplantation; Postprophylaxis; QuantiFERON-cytomegalovirus; Valganciclovir.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Ethical Committee of Medical University of Warsaw and complied with the provisions of the Good Clinical Practice Guidelines and the Declaration of Helsinki. All patients provided written informed consent prior to participation.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Baseline characteristics of the study participants
Fig. 2
Fig. 2
Incidence of CMV infection stratified according to QuantiFERON-CMV with regard to the recipient’s pretransplant CMV IgG serology
Fig. 3
Fig. 3
Time to development of CMV infection in patients with a positive (red line) vs. negative (blue line) QuantiFERON-CMV assay result. formula image QF-CMV negative, formula image QF-CMV positive
See this image and copyright information in PMC

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