Table 1. Virological and immunological monitoring of the four groups of solid-organ transplant recipients with or without HCMV infection reactivation.
Follow-up(days) | T-cell count/µl blood median (range) | HCMV infection | ||||||||||
Absolute | Specific | Onset | Duration | DNA peak | ||||||||
CD4+ | CD8+ | CD4+ | CD8+ | Median daysPosttx (range) | Median days (range) | Mediancopies/mlblood (range) | Median days post tx (range) | |||||
Onset1 | End1 | Onset | End | Onset | End | Onset | End | |||||
Group 1 (no HCMV reactivation, n = 7, 6 KTR and 1 HTR) | ||||||||||||
1–365 | 604 | 542 | 548 | 703 | 4.8 | 2.9 | 2.2 | 40.0 | NA | NA | NA | NA |
(257–1,515) | (191–1,458) | (239–879) | (267–1,414) | (0.5–10.5) | (0.7–63.8) | (0.5–94.8) | (3.2–87.3) | |||||
Group 2 (HCMV reactivation controlled by specific CD4+ and CD8+ T-cells, n = 14, 12 KTR and 2 HTR) | ||||||||||||
1–365 | 488 | 677 | 300 | 573 | 3.6 | 5.9 | 8.7 | 67.7 | 34 | 120 | 1,300 | 58 |
(832,159) | (228–911) | (58–1154) | (253–1,862) | (0.1–16.4) | (0.4–23.8) | (0.1–87.1) | (18.3–220.8) | (12–113) | (6–363) | (200–35,000) | (14–226) | |
Group 3 (HCMV reactivation temporarily controlled by specific CD8+ T-cells, n = 9, 4 KTR and 5 HTR) | ||||||||||||
1–902 | 506 | 535 | 218 | 452 | 0.1 | 0.6 | 0.4 | 22.3 | 30 | 116 | 10,200 | 44 |
(107–1,003) | (167–1,652) | (92–372) | (133–1,363) | (0.1–0.3) | (0.1–6.8) | (0.1–11.4) | (0.5–90.5) | (6–44) | (30–399) | (1,950–259,000) | (18–52) | |
91–3652 | 444 | 394 | 554 | 597 | 0.8 | 0.7 | 27 | 55.9 | 350 | 110 | ||
(232–1,685) | (189–1,446) | (329–1,136) | (159–870) | (0.4–1.3) | (0.3–2.9) | (8.4–66.3) | (21–212.6) | (<25–287,200) | (91–346) | |||
Group 4 (uncontrolled HCMV reactivation and need for antiviral treatment, n = 9, 3 KTR and 6 HTR) | ||||||||||||
1–365 | 198 | 401 | 195 | 1021 | 0.1 | 0.7 | 0.8 | 29.5 | 25 | 182 | 308,0003 | 48 |
(22–975) | (250–1,118) | (60–815) | (727–2,391) | (0.1–0.9) | (0.1–6.7) | (0.1–8.7) | (5.3–323.5) | (14–37) | (50–347) | (119,900–858,000) | (41–136) |
NA, not applicable.
Follow-up.
Patients of this group showed HCMV specific CD8+ only, until about 3 months after transplantation, then developed HCMV-specific CD4+ T-cells.
In some cases, clinicians preferred initiating antiviral therapy after reaching 100,000 (instead of 300,000) DNA copies/ml blood due to presence of end-organ disease.