TY - JOUR
T1 - Management of human cytomegalovirus infection in transplantation
T2 - Validation of virologic cut-offs for preemptive therapy and immunological cut-offs for protection
AU - Gerna, Giuseppe
AU - Lilleri, Daniele
AU - Furione, Milena
AU - Baldanti, Fausto
PY - 2011/7
Y1 - 2011/7
N2 - Human cytomegalovirus (HCMV) still causes major viral complications in the post-transplant period of both solid-organ (SO) and hematopoietic stem cell (HSC) transplant (T) recipients (R). Diagnosis of HCMV infection is mostly made by real-time PCR-based methodologies, which allow quantification of viral DNA in both blood and, if required, organ tissues or local secretions. HCMV infection/disease can be prevented by either universal prophylaxis or preemptive therapy. The latter approach has mostly been used in European Transplantation Centers upon reaching predetermined cut-off levels of viral load, predictive of high risk for HCMV disease. In our Department, these cut-offs are higher for SOTR (3×l0
5 DNA copies/ml whole blood) and lower for HSCTR (3×l0
4 DNA copies/ml). Antiviral therapy is continued until viral DNA disappearance from blood or tissues. However, the authentic long-term control of HCMV infection is achieved when HCMV-specific CD4
+ and CD8
+ T-cells are detected in blood or tissues. Proposed immunological cut-off levels conferring protection are: one HCMV-specific CD4
+ and three CD8
+ T-cells/μl blood for HSCTR, and 0.4 HCMV-specific T-cells/μl for both CD4
+ and CD8f in SOTR. However, anti-rejection in SOTR and anti-GvHD in HSCTR steroid therapies make patients susceptible to HCMV infection, even in the presence of protective levels of specific T-cells.
AB - Human cytomegalovirus (HCMV) still causes major viral complications in the post-transplant period of both solid-organ (SO) and hematopoietic stem cell (HSC) transplant (T) recipients (R). Diagnosis of HCMV infection is mostly made by real-time PCR-based methodologies, which allow quantification of viral DNA in both blood and, if required, organ tissues or local secretions. HCMV infection/disease can be prevented by either universal prophylaxis or preemptive therapy. The latter approach has mostly been used in European Transplantation Centers upon reaching predetermined cut-off levels of viral load, predictive of high risk for HCMV disease. In our Department, these cut-offs are higher for SOTR (3×l0
5 DNA copies/ml whole blood) and lower for HSCTR (3×l0
4 DNA copies/ml). Antiviral therapy is continued until viral DNA disappearance from blood or tissues. However, the authentic long-term control of HCMV infection is achieved when HCMV-specific CD4
+ and CD8
+ T-cells are detected in blood or tissues. Proposed immunological cut-off levels conferring protection are: one HCMV-specific CD4
+ and three CD8
+ T-cells/μl blood for HSCTR, and 0.4 HCMV-specific T-cells/μl for both CD4
+ and CD8f in SOTR. However, anti-rejection in SOTR and anti-GvHD in HSCTR steroid therapies make patients susceptible to HCMV infection, even in the presence of protective levels of specific T-cells.
KW - CD4 T-cells
KW - CD8 T-cells
KW - Hematopoietic stem cell transplant
KW - Human cytomegalovirus
KW - Immunological cut-off
KW - Pre-emptive therapy
KW - Solid organ transplant
KW - Viral load cut-off
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M3 - Article
C2 - 21811744
AN - SCOPUS:84860390349
VL - 34
SP - 229
EP - 254
JO - New Microbiologica
JF - New Microbiologica
SN - 1121-7138
IS - 3
ER -