In:
The Journal of Infectious Diseases, Oxford University Press (OUP), Vol. 220, No. 5 ( 2019-07-31), p. 761-771
Abstract:
Rabbit antithymocyte globulin (rATG) induction is associated with profound immunosuppression, leading to a higher risk of cytomegalovirus (CMV) infection compared with anti–interleukin 2 receptor antibody (anti–IL-2RA). However, this risk, depending on the baseline CMV serological recipient/donor status, is still controversial. Methods The CMV DNAemia-free survival between rATG- and anti–IL-2RA–treated patients was analyzed in donor-positive/recipient-negative (D+R−) and recipient-positive (R+) patients in 1 discovery cohort of 559 kidney transplant recipients (KTRs) and 2 independent cohorts (351 and 135 kidney KTRs). The CMV-specific cell-mediated immunity (CMI) at baseline and at different time points after transplantation was assessed using an interferon γ enzyme-linked immunosorbent spot assay. Results rATG increased the risk of CMV DNAemia in R+ but not in D+R− KTRs. In R+ CMI-positive (CMI+) patients, the CMV DNAemia rate was higher in rATG-treated than in anti–IL-2RA–treated patients; no difference was observed among R+ CMI-negative (CMI−) patients. Longitudinal follow-up demonstrated a deeper depletion of preformed CMV CMI in R+ rATG-treated patients. Conclusions D+R− KTRs have the highest risk of CMV DNAemia, but rATG adds no further risk. Among R+ KTRs, we described 3 groups, the least prone being R+CMI+ KTRs without rATG, then R+CMI+ KTRs with rATG, and finally R+CMI− KTRs. CMV serostatus, baseline CMV-specific CMI, and induction therapy may lead to personalized preventive therapy in further studies.
Type of Medium:
Online Resource
ISSN:
0022-1899
,
1537-6613
DOI:
10.1093/infdis/jiz194
Language:
English
Publisher:
Oxford University Press (OUP)
Publication Date:
2019
detail.hit.zdb_id:
1473843-0
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