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PubMed | French Institute of Health and Medical Research, Bordeaux University Hospital Center and Transplantation and Dialysis and.
Type: Journal Article | Journal: Journal of the American Society of Nephrology : JASN | Year: 2016

Cytomegalovirus (CMV) infection in solid-organ transplantation is associated with increased morbidity and mortality, particularly if a CMV mutant strain with antiviral resistance emerges. Monitoring CMV-specific T cell response could provide relevant information for patient care. We and others have shown the involvement of V2(neg) T cells in controlling CMV infection. Here, we assessed if V2(neg) T cell kinetics in peripheral blood predict CMV infection resolution and emergence of a mutant strain in high-risk recipients of kidney transplants, including 168 seronegative recipients receiving organs from seropositive donors (D+R-) and 104 seropositive recipients receiving antithymocyte globulins (R+/ATG). V2(neg) T cell percentages were serially determined in patients grafted between 2003 and 2011. The growing phase of V2(neg) T cells was monitored in each infected patient, and the expansion rate during this phase was estimated individually by a linear mixed model. A V2(neg) T cell expansion rate of 0.06% per day predicted the growing phase. The time after infection at which an expansion rate of 0.06% per day occurred was correlated with the resolution of CMV DNAemia (r=0.91; P<0.001). At 49 days of antiviral treatment, V2(neg) T cell expansion onset was associated with recovery, whereas absence of expansion was associated with recurrent disease and DNAemia. The appearance of antiviral-resistant mutant CMV strains was associated with delayed V2(neg) T cell expansion (P<0.001). In conclusion, longitudinal surveillance of V2(neg) T cells in recipients of kidney transplants may predict CMV infection resolution and antiviral drug resistance.

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