Artikel
Testing of CMV-specific interferon-γ release in whole blood is not predictive for the development of CMV viremia in kidney and stem cell transplant patients
Fehlende Vorhersage einer CMV-Virämie durch einen CMV-QuantiFERON Vollblut Test bei Patienten nach Nieren- und Stammzelltransplantation
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Veröffentlicht: | 2. Juni 2010 |
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Gliederung
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Introduction: Cytomegalovirus (CMV) reactivation remains a significant cause of morbidity both in kidney (KTR) and hematopoietic stem cell transplantation recipients (HCTR). A diminished CMV-specific T-cell response might be a better predictor of CMV reactivation compared to plasma viremia. We hypothesized that patients (pts) with negative or indeterminate results of QuantiFERON-CMV whole blood assay (C-QFT, Cellestis, Australia) would be at greater risk for reactivation of CMV disease due to impaired or absent CMV-specific cellular immunity.
Methods: We prospectively performed C-QFT in 48 healthy controls and 198 pts (KTR n=91; HCTR n=107, table) before and within 1 year after transplantation. After exclusion of D-/R- pts, charts of 152 pts were retrospectively evaluated for CMV viremia (cut-off, 1000 copies/ml plasma) or CMV-therapy. Kaplan-Meier curves and Cox regression were computed to assess viremia-free follow-up according to different C-QFT results. Logistic regression analysis identified risk factors for CMV viremia/antiviral therapy.
Results: C-QFT was positive in 13/17 (77%) CMV-seropos. and negative in 28/31 (90%) CMV-seroneg. controls, respectively. In 69/78 (88%) tests performed in D-/R- pts (19/21=90% in KTR, 50/57=88% in HCTR) C-QFT was negative. 76 pts (50%) had either negative or indeterminate C-QFT and in 76 (50%) pts the C-QFT result was positive. 69 (45%) pts developed viremia at any point after C-QFT, 51% in negative or indeterminate C-QFT pts compared to 40% in pts with positive C-QFT (x2 p>0.05). 35/61 pts that were tested with C-QFT before or 1 month after transplantation had a negative or indeterminate results. 13 (37%) of those developed viremia in the next 100 days compared to 13/26 (50%) with a positive C-QFT result (x2 p>0.05, Figure 1 [Fig. 1]). There was no significant difference in CMV reactivation according to C-QFT status in different transplant or risk groups. In regression analyses C-QFT negative or indeterminate results were not associated with viremia or indication for therapy.
Discussion: We found no association of C-QFT results with subsequent CMV reactivation in KTR and HCTR.
References
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