1. ¹Department of Internal Medicine III, Charité, Campus Benjamin Franklin, Hindenburgdamm, Berlin, Germany
2. ²Department of Internal Medicine, Division of Hematology and Oncology, University Hospital Leipzig, Johannisallee, Leipzig, Germany
3. ³Institute of Virology, Charite, Berlin, Germany
4. ⁴Institute of Virology, University of Leipzig, Johannisallee, Leipzig, Germany
5. ⁵Department of Virology, Charite, Campus Benjamin Franklin, Hindenburgdamm, Berlin, Germany

Correspondence: Dr S Ganepola, Department of Internal Medicine III, Charité, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany. E-mail: susanne.ganepola@charite.de

Received 10 May 2006; Revised 11 December 2006; Accepted 15 December 2006; Published online 29 January 2007.

Abstract

Human cytomegalovirus (CMV) is a major cause of death after transplantation. The frequency of pp65-specific T cells was examined in 38 HLA-A2+ stem cell recipients during the first year after transplantation. Patients were divided into four groups based on donor/recipient serostatus: d+/r+ (n=17), d+/r- (n=7), d-/r+ (n=9) and d-/r- (n=5). Peripheral blood mononuclear cells were stimulated with the CMVpp65 peptide NLVPMVATV, and the specific T-cell frequency was assessed by interferon gamma (IFN-) ELISPOT assay. Responding T cells were characterized by flow cytometry revealing a terminal differentiated effector phenotype. Surveillance of CMV infection was carried out by real-time polymerase chain reaction (n=26) or immunofluorescence (n=12). Infection was present in 7/9 d-/r+ high-risk patients, and CMV disease occurred exclusively in this group with delayed or absent virus-specific T-cell recovery. In contrast, 16/24 intermediate-risk patients showed CMV-specific T cells. Our data suggest that CMV infection and disease rates are elevated in high-risk patients with delayed CMV-specific T-cell immune reconstitution and lower in those with early recovery of T-cell immunity. We recommend preferring CMV seropositive donors for CMV seropositive recipients, as this should lead to durable CMV-specific T-cell responses soon after transplantation with consecutive protection from CMV disease.