PURPOSE: Describe use and predictive potential of an intracellular cytokine staining (ICS) cytomegalovirus cell-mediated immunity (CMV CMI) assay and a risk factor screening tool on CMV reactivation in a real-world clinical setting and compare this to serologically demonstrated immunity by CMV IGG. METHODS: Adult transplant patients at our center with the ICS assay resulted between 10/1/2018 and 9/1/2019 were included. Assays were considered positive per manufacturer specifications. RESULTS: Twenty-five patients underwent ICS CMV CMI testing at our institution during the study period. The majority were kidney transplant recipients, 76% were D+/R-, and 76% were receiving CMV treatment. The positive predictive value (PPV) of the assay to predict lack of CMV was 87%; 93% when patients with antiviral resistance were excluded and 91% in only those receiving treatment. The presence of ≤2 clinical risk factors on the screening tool had a PPV of 92% in predicting lack of recurrence. In comparison, serologically demonstrated immunity by CMV IGG had a PPV of 62%. CONCLUSIONS: In our study representing real-world clinical use, the ICS CMV CMI assay and the risk factor screening tool had predictive potential that was superior to serologically demonstrated immunity. The reliability of the assay seemed to decrease with higher degrees of clinical risk suggesting a multimodal screening approach is warranted.
PURPOSE: Describe use and predictive potential of an intracellular cytokine staining (ICS) cytomegalovirus cell-mediated immunity (CMV CMI) assay and a risk factor screening tool on CMV reactivation in a real-world clinical setting and compare this to serologically demonstrated immunity by CMV IGG. METHODS: Adult transplant patients at our center with the ICS assay resulted between 10/1/2018 and 9/1/2019 were included. Assays were considered positive per manufacturer specifications. RESULTS: Twenty-five patients underwent ICS CMV CMI testing at our institution during the study period. The majority were kidney transplant recipients, 76% were D+/R-, and 76% were receiving CMV treatment. The positive predictive value (PPV) of the assay to predict lack of CMV was 87%; 93% when patients with antiviral resistance were excluded and 91% in only those receiving treatment. The presence of ≤2 clinical risk factors on the screening tool had a PPV of 92% in predicting lack of recurrence. In comparison, serologically demonstrated immunity by CMV IGG had a PPV of 62%. CONCLUSIONS: In our study representing real-world clinical use, the ICS CMV CMI assay and the risk factor screening tool had predictive potential that was superior to serologically demonstrated immunity. The reliability of the assay seemed to decrease with higher degrees of clinical risk suggesting a multimodal screening approach is warranted.
Authors: Margaret R Jorgenson; Jillian L Descourouez; Cynthia Wong; Jill R Strayer; Sandesh Parajuli; John P Rice; Robert R Redfield; Jeannina A Smith; Didier A Mandelbrot; Christopher M Saddler Journal: Transpl Infect Dis Date: 2021-03-15