QuantiFERON® CMV use in solid organ transplantation‎: a retrospective study in the university hospital of Grenoble ; Utilisation du Quantiferon® CMV en transplantation d’organe solide : étude rétrospective monocentrique au CHU Grenoble Alpes

Background: Recommendations for management of Cytomegalovirus (CMV) infection among solid organ transplant (SOT) recipients are currently based on type of transplanted organ, CMV serostatus, immunosuppressive regimen, and CMV viral load. Assessment of CMV-specific cell-mediated-immunity (CMV-specific CMI) is an attractive strategy for individualising antiviral strategy after transplantation. Method: In this study, we first reviewed studies evaluating CMV-specific CMI assays to manage CMV infection in SOT recipients. Then, we explored how one assay, the QuantiFERON® CMV (QF CMV), was used by conducting a monocentric and retrospective study in the University hospital of Grenoble. Objectives: We analysed whether QF CMV result realised before transplantation, at the end of primary and at the end secondary prophylaxis, was associated with CMV relevant infection (CMV viral load > 1000 c/ml) thereafter, and whether QF CMV result realised when CMV infection occurs was associated with spontaneous viral clearance of the infection. Results: One hundred and forty QF CMV, realised on 105 solid organ transplant recipients, were analysed. Factors associated with QF CMV result were blood level of lymphocyte (p<0.001), acid mycophenolic dose (p<0.001) and prednisone dose (p=0.003). QF CMV result pretransplant was not associated with significant variations in the incidence of relevant CMV infection after transplantation (which occurred in 58% [7/12] of patients with non-immune-reactive (NIR) QF CMV versus 35% [6/17] of patients with immune-reactive (IR) QF CMV [p=0,108]). QF CMV result at the end of prophylaxis was not associated with significant variations in the incidence of relevant CMV infection after primary prophylaxis withdrawal (which occurred in 63% [5/8] of patients with NIR QF CMV versus 30% [3/10] of patients with IR QF CMV [p=0.168]), or secondary prophylaxis withdrawal (which occurred in 75% [3/4] of patients with NIR QF CMV versus 57% [8/14] of patients with IR QF CMV [p=0.518]). When CMV infection occurs, ...