Natural killer and T-cell immunity pretransplant as a predictor for cytomegalovirus post-transplant

Pre-transplant CMV specific T-cell and NK-cell responses could predict the risk of CMV reactivation following transplantation. We tested this hypothesis in a large cohort of CMV seropositive transplant recipients enrolled in five centers. No patient received antiviral prophylaxis and all had regular viral load monitoring. PBMCs were stimulated with live virus followed by immunophenotyping of T and NK-cell subsets including CD4, CD8, T-reg populations (CD4+CD25+ FOXP3+), CD16, CD56, NKG2C, and IFN-?. The primary outcome was viremia requiring antiviral therapy within the first 3-months post-transplant. A total of 272 CMV R+ transplant patients were analyzed. Transplant types included kidney (65.4%), liver (23.5%), and other (11.1%). CMV viremia occurred in 83/272(30.7%) and disease in 10/272 (3.7%). This study provides novel insight into pre-transplant evaluation of T and NK cell phenotypes and subsequent risk of CMV reactivation.