Factors related to the development of CMV-specific CD8+ T cell response in CMV-seropositive solid organ transplant candidates.

This cross-sectional study analyzes factors associatedwith the development of CMV-specific CD8þ response,measured by IFNg production after cytomegalovirus(CMV) peptide stimulation, in CMV-seropositive solidorgan transplantation candidates. A total of 114candidates were enrolled, of whom 22.8% (26/114)were nonreactive (IFNg<0.2IU/mL). Multivariate logis-ticregressionanalysisshowedthatage,HLAallelesandorgan to be transplanted were associated with devel-oping CMV-specific CD8þ immunity (reactive; IFNg 0.2IU/mL). The probability of being reactive washigher in candidatesover 50 than in those under 50 (OR6.33,95%CI1.93–20.74).CandidateswithHLA-A1and/orHLA-A2alleleshadahigherprobabilityofbeingreactivethan those with non-HLA-A1/non-HLA-A2 alleles (OR10.97, 95%CI 3.36–35.83). Renal candidates had a higherprobability of being reactive than lung (adjusted OR8.85, 95%CI 2.24–34.92) and liver candidates (OR 4.87,95%CI 1.12–21.19). The AUC of this model was 0.84(p<0.001).Positiveandnegativepredictivevalueswere84.8% and 76.9%, respectively. In renal candidateslonger dialysis was associated with an increasedfrequency of reactive individuals (p¼0.040). Therefore,although the assessment of CMV-specific CD8þ re-sponse is recommended in all Rþ candidates, it isessential in those with a lower probability of beingreactive, such as non-renal candidates, candidatesunder50orthosewithnon-HLA-A1/non-HLA-A2alleles.Abbreviations: AUC, area under the curve; CMV,cytomegalovirus; IFNg, interferon-gamma; QF-CMV,QuantiFERON-CMV; Rþ, CMV-seropositive recipient;R-, CMV-seronegative recipientReceived11June2014,revised10September2014andaccepted for publication 11 September 2014