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Title: Early viral-specific T-cell testing predicts late cytomegalovirus reactivation following liver transplantation.
Austin Authors: Sood, Siddharth ;Haifer, C;Yu, L;Pavlovic, J ;Gow, Paul J ;Jones, Robert M ;Visvanathan, Kumar;Angus, Peter W ;Testro, Adam G 
Affiliation: Victorian Liver Transplant Unit
Department of Gastroenterology & Hepatology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
Innate Immune Laboratory, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
Issue Date: 29-May-2018
Date: 2018-05-29
Publication information: Transplant Infectious Disease : an Official Journal of the Transplantation Society 2018; 20(5): e12934
Abstract: Although antiviral prophylaxis is effective in preventing early cytomegalovirus (CMV) reactivation following liver transplantation (OLT), it predisposes patients to late CMV after prophylaxis has ceased. QuantiFERON-CMV (QFN-CMV, Qiagen, The Netherlands) measures an individual's viral-specific immune response. Fifty-nine OLT recipients were prospectively monitored post-OLT in an observational cohort study. QFN-CMV was performed at regular time-points. An absolute QFN-CMV <0.1 IU/mL was considered non-reactive. 50/59 (84.7%) had a reactive QFN-CMV by M6. 38/59 (64.4%) had antiviral prophylaxis or treatment before M6, with 31/38 (81.6%) developing a reactive QFN-CMV by 6 months. Over 90% already had a reactive result as early as 3 months post transplant, 3 patients (5.08%) developed late CMV between 6-12 months (median 251 days)-all had a non-reactive M6 QFN-CMV. And 2/3 experienced CMV disease. Non-reactive M6 QFN-CMV was significantly associated with late CMV (OR = 54.4, PPV = 0.33, NPV = 1.00, P = .003). Although only 5% of recipients developed late CMV, 2/3 suffered CMV disease. M6 QFN-CMV has an excellent NPV for late CMV, suggesting patients who exhibit a robust ex vivo immune response at M6 can safely cease CMV monitoring. Furthermore, >90% already express viral-specific immunity as early as 3 months. Conceivably, antiviral prophylaxis could be discontinued early in these patients.
DOI: 10.1111/tid.12934
ORCID: 0000-0002-9341-4792
Journal: Transplant Infectious Disease : an Official Journal of the Transplantation Society
PubMed URL: 29809312
Type: Journal Article
Subjects: CMV disease
late CMV
liver transplantation
Appears in Collections:Journal articles

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