Virologic and immunologic monitoring of cytomegalovirus to guide preemptive therapy in solid-organ transplantation

G. Gerna, D. Lilleri, A. Chiesa, P. Zelini, M. Furione, G. Comolli, C. Pellegrini, E. Sarchi, C. Migotto, M. Regazzi Bonora, F. Meloni, E. Arbustini

Research output: Contribution to journalArticlepeer-review


Control of human cytomegalovirus (HCMV) infection during the posttransplant period was investigated in 134 solid-organ transplant recipients by monitoring in parallel virologic and immunologic parameters for at least 1 year of follow-up. Virologic monitoring was achieved by determining HCMV DNAemia with real-time PCR, using the threshold of 300 000 DNA copies/mL blood as a cutoff for starting preemptive therapy. Immunologic monitoring included measurement of HCMV-specific CD4+ and CD8+ T cells by cytokine flow cytometry, using HCMV-infected dendritic cells as a stimulus. HCMV infection was diagnosed in 110 (82%) and required treatment in 49 (36%) patients. At 12 months after transplantation 'protective' immunity (≥0.4 CD4+ and CD8+ HCMV-specific T cells/lL blood) was achieved in 115/129 (89%) patients. During the entire study period, 122 patients reconstituting HCMV-specific CD4+ and CD8+ T-cell immunity at 60 days posttransplant onward were able to control HCMV infection, except for one patient who developed HCMV disease because of a rejection episode. Patients reconstituting HCMV-specific CD8+ only did not control HCMV infection. In conclusion, the presence of both HCMV-specific CD4+ and CD8+ T cells ≥ 0.4/lL blood appears to be protective against HCMV disease. This result does not apply to patients undergoing antirejection treatment, or reconstituting HCMV-specific CD8+ T cells only.

Original languageEnglish
Pages (from-to)2463-2471
Number of pages9
JournalAmerican Journal of Transplantation
Issue number11
Publication statusPublished - Nov 2011


  • Human cytomegalovirus
  • Immunologic monitoring
  • Preemptive therapy
  • Solid-organ transplant recipients
  • Virologic monitoring

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)


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