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Baldanti F, Lucchini G, Lilleri D, et al. Sustained impairment of human cytomegalovirus (HCMV)-specific CD4+ and CD8+ T cell response is responsible for recurrent episodes of disseminated HCMV infection in a D+R- hand transplant recipient. Cases J. 2008;1(1):155doi: 10.1186/1757-1626-1-155.
Baldanti, F., Lucchini, G., Lilleri, D., & Lanzetta, M. (2008). Sustained impairment of human cytomegalovirus (HCMV)-specific CD4+ and CD8+ T cell response is responsible for recurrent episodes of disseminated HCMV infection in a D+R- hand transplant recipient. Cases journal, 1(1), 155. https://doi.org/10.1186/1757-1626-1-155
Baldanti, Fausto, et al. "Sustained impairment of human cytomegalovirus (HCMV)-specific CD4+ and CD8+ T cell response is responsible for recurrent episodes of disseminated HCMV infection in a D+R- hand transplant recipient." Cases journal vol. 1,1 (2008): 155. doi: https://doi.org/10.1186/1757-1626-1-155
Baldanti F, Lucchini G, Lilleri D, Lanzetta M. Sustained impairment of human cytomegalovirus (HCMV)-specific CD4+ and CD8+ T cell response is responsible for recurrent episodes of disseminated HCMV infection in a D+R- hand transplant recipient. Cases J. 2008 Sep 17;1(1):155. doi: 10.1186/1757-1626-1-155. PMID: 18798988; PMCID: PMC2556316.
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Cases J. 2008 Sep 17;1(1):155. doi: 10.1186/1757-1626-1-155.

Sustained impairment of human cytomegalovirus (HCMV)-specific CD4+ and CD8+ T cell response is responsible for recurrent episodes of disseminated HCMV infection in a D+R- hand transplant recipient.

Cases journal

Fausto Baldanti, Giovanna Lucchini, Daniele Lilleri, Marco Lanzetta

Affiliations

  1. Servizio di Virologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. [email protected].

PMID: 18798988 PMCID: PMC2556316 DOI: 10.1186/1757-1626-1-155

Abstract

Human cytomegalovirus (HCMV) infection is the major viral complication in solid organ transplant recipients. Seronegative recipents (R-) of organs from seropositive donors (D+) appear to be at higher risk of developing symptomatic HCMV infection. To what extent systemic life-threatening complications can be risked for non-life-saving transplant procedures? A case report describing successful treatment of repeated episodes of active HCMV infection in a D+R- hand recipient in the absence of HCMV-specific T-cell immunity is presented. In the attempt to save both the patient and the transplanted hand, a preemptive treatment strategy was adopted with the aim to boost the constitution of the virus-specific T-cell immune response and simultaneously avoid onset of disease. Careful monitoring of HCMV load in blood and HCMV-specific T-cell immunity guided administration of repeated courses of antiviral treatment and avoided emergence of HCMV-related symptoms. Following establishment of HCMV-specific CD4+ and CD8+ T-cell response, preemptive treatment was no longer required due to sustained HCMV disappearance from blood. The patient is now well, and his hand too. In conclusion, evaluation of virus-specific T-cell immunity is of crucial importance in D+R- transplant recipients and careful monitoring of HCMV-specific T cell mediated response should always parallel monitoring of HCMV load in transplant recipients.

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