Role of cytomegalovirus specific cell‐mediated immunity in the monitoring of cytomegalovirus infection among living donor liver transplantation adult recipients: A single‐center experience

Abstract

AbstractBackgroundCytomegalovirus (CMV) is one of the most common post‐transplant viral infections causing significant morbidity and occasional mortality. Limited literature on the potential role of pre‐transplant CMV‐specific cell‐mediated immunity (CMV‐CMI) is available. This study aimed to evaluate the clinical utility of pre‐transplant CMV‐CMI monitoring in the occurrence of post‐transplant CMV infection.MethodsThis was a prospective, observational study where all adult CMV seropositive patients undergoing living donor liver transplantation at a tertiary care institute were enrolled. CMV‐CMI was measured using QuantiFERON‐CMV (Qiagen GmbH, Hilden, Germany) and interpreted as positive if the value was ≥0.2 IU/ml, 1–2 days prior to the transplant. Based on pre‐transplant CMV‐CMI, cases were classified into Group 1 (n = 13, 43.3%) (positive) and Group 2 (n = 17, 56.7%) (negative). CMV infection was defined as the detection of CMV‐DNA > 2.7 log10 IU/ml in plasma specimens.ResultsThe mean age was 43 years with male (n = 29, 96.9%) predominance. Overall 40% of recipients developed post‐transplant CMV infection, two (15.4%) in group 1 and 10 (58.8%) in group 2 (p‐value = 0.016). Recipients in group 2 had 87% higher odds (odds ratio 0.13, confidence interval [CI] 95) of developing post‐transplant CMV infection compared to group 1. The overall median duration of occurrence of post‐transplant CMV infection was 26 days with the median viral load being 2.8 log10 IU/ml. The treatment duration was 13 days in group 1 and 28 days in group 2 (p = 0.003). Group 1 recipients showed rapid clearance of CMV‐DNA within 7 days compared to group 2 in which it was 21 days (p = 0.004, CI 95).ConclusionPre‐transplant CMV‐CMI may play a protective role against post‐transplant CMV infection and can serve as an adjunct for pre‐transplant risk stratification. image