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Different impact of rATG induction on CMV infection risk in D+R– and R+ KTRs
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Different impact of rATG induction on CMV infection risk in D+R– and R+ KTRs
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Journal Article
Different impact of rATG induction on CMV infection risk in D+R– and R+ KTRs
2019
Overview
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.
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.
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.
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.
Publisher
Oxford University Press
Subject
/ Antilymphocyte Serum - immunology
/ Antiviral Agents - therapeutic use
/ Cytomegalovirus - immunology
/ Cytomegalovirus Infections - immunology
/ Female
/ Humans
/ Immunosuppressive Agents - administration & dosage
/ Interleukin-2 Receptor alpha Subunit - immunology
/ Kidney Transplantation - adverse effects
/ Male
/ VIRUSES
