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

Fausto Baldanti,Marco Lanzetta,Giovanna Lucchini,Daniele Lilleri

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.

Highlights

Since the first successful hand transplantation in Lyon in 1998, 38 hands (18 unilateral and 10 bilateral) and two digits have been transplanted in 30 individuals in different countries [1]
Coincidental with the lack of http://www.casesjournal.com/content/1/1/155 virus (HCMV)-specific CD4+ and CD8+ T cell response was the consistent positivity of viral markers in blood prompting antiviral treatment, while recovery of HCMV-specific CD4+ and CD8+ T-cell reponses was associated with spontaneous resolution of viral infection (Figure 1A and 1B)
In the great majority of D+R- solid organ transplant recipients (SOTR), HCMV primary infection can be successfully controlled by antiviral treatment

Summary

Introduction

Since the first successful hand transplantation in Lyon in 1998, 38 hands (18 unilateral and 10 bilateral) and two digits have been transplanted in 30 individuals in different countries [1]. The case of a D+R- hand transplant recipient with recurrent episodes of disseminated HCMV infection associated with impaired HCMV-specific CD4+ and CD8+ T cell response is described. The prolonged and repeated episodes of HCMV disseminated infection in the absence of other opportunistic infections suggested a potential selective impairment of HCMV-specific T-cell mediated immune response.

Results

Conclusion