Pretransplant CMV-specific T-cell immunity but not dose of antithymocyte globulin is associated with recovery of specific immunity after kidney transplantation

Resumen:
Background: This is a prospective, multicenter, observational study in cytomegalovirus (CMV)-seropositive kidney transplant recipients with pretransplant CMV-specific cell-mediated immunity (CMV-CMI) receiving antithymocyte globulin (ATG). We aimed to investigate posttransplant CMV-CMI over time as well as the impact of the dose-dependent ATG. Methods: CMV-CMI was assessed at days +30, +45, +60 and +90 after transplantation with the QuantiFERON-CMV assay. A "Reactive" result (IFNG ¿0.2 UI/mL) indicated a positive CMV-CMI. Results: A total of 78 positive CMV-CMI patients were enrolled in the study, of which 59.5% had a positive CMV-CMI at day +30 and 82.7% at day +90. Multivariate logistic regression analysis showed that the ATG dose was not associated with positive CMV-CMI at any point. However, pretransplant IFNG level (>12 IU/mL vs. ¿12 IU/mL) was associated with having positive CMV-CMI at day +30 (OR 12.9; 95% CI 3.1-53.3; P < .001). In addition, all the patients who did not recover CMV-CMI at day +90 had a pretransplant IFNG level ¿12 IU/mL. Conclusion: More than half of CMV-seropositive kidney transplant recipients receiving ATG recover (or maintain) CMV-CMI by the first month after transplantation The pretransplant IFNG level, but not the ATG dose, shows a strong association with the kinetics of this recovery.