Management of human cytomegalovirus infection in transplantation: Validation of virologic cut-offs for preemptive therapy and immunological cut-offs for protection

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)229-254
Number of pages26
JournalNew Microbiologica
Volume34
Issue number3
Publication statusPublished - Jul 2011

Keywords

  • CD4 T-cells
  • CD8 T-cells
  • Hematopoietic stem cell transplant
  • Human cytomegalovirus
  • Immunological cut-off
  • Pre-emptive therapy
  • Solid organ transplant
  • Viral load cut-off

ASJC Scopus subject areas

  • Microbiology (medical)

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