2294. Utilization of Quantiferon-Cytomegalovirus Assay to Assess the Risk of CMV Disease and Guide Duration of Antiviral Prophylaxis in CMV-Mismatched Solid Organ Transplant Recipients
Session: Poster Abstract Session: Transplants: CMV and Transplantation
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • IDWeekQFTPoster2016estv2.pdf (217.3 kB)
  • Background:

    Cytomegalovirus (CMV) causes significant morbidity after solid organ transplantation (SOT). CMV-seronegative recipients of organs from seropositive donors (D+R-) are at highest risk despite antiviral prophylaxis. Moreover, prolonged antiviral prophylaxis is associated with significant cost and toxicity. Ideally, an optimized risk stratification of D+/R- SOT recipients would individualize the duration of prophylaxis. We hypothesized that development of an interferon-gamma (IFN-γ) response to CMV is protective against CMV disease, and could guide prophylaxis.

    Methods:

    After obtaining consent, blood samples were collected at baseline within 1 week after SOT, then monthly thereafter for 6 months. CMV-specific immunity was assessed using the Quantiferon-CMV (QFT-CMV) IFN- γ release assay (IGRA). Patients were followed for up to 12 months post-transplant.

    Results:

    Twenty subjects completed all measurements, 13 (65%) were male; median age of 60 years. The transplanted organs included: 9 (45%) kidneys, 7 (35%) livers, 1 (5%) heart, 1 (5%) lung, 1 (5%) heart/liver and 1 (5%) pancreas. Induction immunosuppression consisted of antithymocyte globulin in 5 (25%) patients, methylprednisolone in 12 (60%), basiliximab in 5 (25%), alemtuzumab in 3 (15%) and azathioprine in 1 (5%). Most were on maintenance immunosuppression with tacrolimus, mycophenolate and prednisone; all received antiviral prophylaxis, except 3 liver recipients who were monitored for CMV and received preemptive therapy.

    Using the suggested cut off of 0.2 IU/mL, all patients were negative at baseline; by months 3 and 6, 3 (15%) and 7 (35%) patients were positive by the QFT-CMV. CMV disease occurred in 6 (30%) patients, of which 3 were no longer on prophylaxis. All had negative QFT-CMV results prior to diagnosis; QFT-CMV testing after infection was available in 5/6 patients, and all tested positive; none had relapsed.

    Conclusion:

    An IFN- γ response to CMV may be acquired even during antiviral prophylaxis. Patients reactive by the QFT-CMV assay were protected from disease. Conversely, non-reactive patients remain at risk for CMV. QFT-CMV may be beneficial in identifying D+/R- SOT recipients who remain at high risk for CMV disease, and may benefit from continued prophylaxis.

    Maria Dioverti, M.D.1, Dante Melendez, MD2, Lori Misner, TECHNICAL SPECIALIST II - DLMP3, Elain Beito, SPV-DLMP3, Elitza Theel, PhD4 and Raymund R. Razonable, MD, FIDSA5, (1)Mayo Clinic, Rochester, MN, (2)Division of Infectious Diseases, Oklahoma University Health Sciences Center, Oklahoma City, OK, (3)Infectious Diseases Serology Laboratory, Mayo Clinic, Rochester, MN, (4)Division of Clinical Microbiology, Mayo Clinic, Rochester, MN, (5)Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN

    Disclosures:

    M. Dioverti, None

    D. Melendez, None

    L. Misner, None

    E. Beito, None

    E. Theel, None

    R. R. Razonable, None

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