Cytomegalovirus Cell-Mediated Immunity: Ready for Routine Use?

Abstract

Antiviral prophylaxis; Cytomegalovirus management; Innate immunity

Profilaxis antiviral; Gestión de citomegalovirus; Inmunidad innata

Profilaxi antiviral; Gestió del citomegalovirus; Immunitat innata

Utilizing assays that assess specific T-cell-mediated immunity against cytomegalovirus (CMV) holds the potential to enhance personalized strategies aimed at preventing and treating CMV in organ transplantation. This includes improved risk stratification during transplantation compared to relying solely on CMV serostatus, as well as determining the optimal duration of antiviral prophylaxis, deciding on antiviral therapy when asymptomatic replication occurs, and estimating the risk of recurrence. In this review, we initially provide an overlook of the current concepts into the immune control of CMV after transplantation. We then summarize the existent literature on the clinical experience of the use of immune monitoring in organ transplantation, with a particular interest on the outcomes of interventional trials. Current evidence indicates that cell-mediated immune assays are helpful in identifying patients at low risk for replication for whom preventive measures against CMV can be safely withheld. As more data accumulates from these and other clinical scenarios, it is foreseeable that these assays will likely become part of the routine clinical practice in organ transplantation.

OB’s research is supported by a research grant network from the RICORS (Redes de Investigación Cooperativa Orientadas a Resultados en Salud) consortia by the Instituto de Salud Carlos III and co-funded by European Union (ERDF/ESF)- A way to build Europe. MF-R holds a research contract “Miguel Servet” (CP18/00073) from the Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, also co-funded by the European Union. OB, HK, LC, and OM participate in the HORUS project, which has received funding from HORIZON Europe under the grant agreement No.101057651.