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Cytomegalovirus Immunity After Alemtuzumab Induction in Desensitized Kidney Transplant Patients.
- Source :
-
Transplantation [Transplantation] 2017 Jul; Vol. 101 (7), pp. 1720-1726. - Publication Year :
- 2017
-
Abstract
- Background: Desensitization with IVIG + rituximab combined with alemtuzumab induction gives HLA-sensitized patients an opportunity for successful kidney transplantation. However, it may be associated with a high risk for viral infections due to combined T cell and B cell depletion.<br />Methods: Anti-cytomegalovirus (CMV) activity was assessed in 280 pretransplant and posttransplant blood samples from 33 desensitized patients who received alemtuzumab induction. CMV-specific CD8+ (CMV-Tc), CD4+ (CMV-Th) T cell activity, and natural killer (NK) cell number were measured by flow cytometry. Anti-CMV IgG was measured by enzyme-linked immunosorbent assay, and CMV DNA by polymerase chain reaction.<br />Results: All 30 CMV sero (+) patients were (+) for CMV-Tc and/or Th predesensitization, while 3 sero (-) patients showed no CMV-T cell activity. CMV-Tc and/or Th became (-) in 50% to 70% of these sero (+) patients at 1 month post-alemtuzumab. However, 75% showed CMV-T cell (+) by 2 months and 95% did so by 3 months post-alemtuzumab. More than 50% of pretranslpant NK cell levels were detected post-alemtuzumab. Anti-CMV IgG levels did not decrease posttransplant in sero (+) patients. Four patients developed CMV viremia with clearance by 1.2 months, which correlated with an increase or appearance of CMV-T cells, even in the sero (-) patient.<br />Conclusions: CMV-T cell activity, anti-CMV IgG, and NK cell-mediated antibody-dependent cell cytotoxicity were present in aleumtuzumab-treated CMV sero (+) patients. One sero (-) patient developed CMV-T cell responses post-CMV viremia. These results suggest that the IVIG + rituximab desensitization combined with alemtuzmab induction with triple immunosuppression maintenance does not result in prolonged suppression of anti-CMV immunity or increased risk for CMV infection.
- Subjects :
- Alemtuzumab
Antibodies, Monoclonal, Humanized adverse effects
Antibodies, Viral blood
Cytomegalovirus immunology
Cytomegalovirus Infections diagnosis
Cytomegalovirus Infections virology
Desensitization, Immunologic adverse effects
Female
Humans
Immunoglobulins, Intravenous therapeutic use
Immunosuppressive Agents adverse effects
Kidney Transplantation adverse effects
Male
Opportunistic Infections diagnosis
Opportunistic Infections virology
Risk Assessment
Risk Factors
Rituximab therapeutic use
T-Lymphocytes immunology
T-Lymphocytes virology
Time Factors
Treatment Outcome
Antibodies, Monoclonal, Humanized therapeutic use
Cytomegalovirus drug effects
Cytomegalovirus Infections immunology
Desensitization, Immunologic methods
Immunocompromised Host
Immunosuppressive Agents therapeutic use
Kidney Transplantation methods
Opportunistic Infections immunology
T-Lymphocytes drug effects
Subjects
Details
- Language :
- English
- ISSN :
- 1534-6080
- Volume :
- 101
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 27841845
- Full Text :
- https://doi.org/10.1097/TP.0000000000001573