BACKGROUND: Cytomegalovirus (CMV) infection is a life-threatening complication after solid organ transplantation. It usually appears in the first months after transplantation as a consequence of immunosuppression. The goal of this study was to evaluate the clinical significance of CD38(high)/CD3(+)8(+) percentages in the detection of CMV infection in patients after kidney transplantation. METHODS: In this retrospective study, 269 patients were monitored 2-3 months after renal transplantation for the percentage of CD38(high)/CD3(+)8(+) lymphocytes estimated by flow cytometry and for the number of CMV DNA copies in peripheral blood using a real-time polymerase chain reaction. RESULTS: CMV infection was diagnosed in 12 (4.5%) patients between the 31st and 63rd days after transplantation, and all of them had percentages of CD38(high)/CD3(+)8(+) T lymphocytes above 20%. In 4 of them, CMV DNAemia in peripheral blood was not detected, and 2 of these suffered from tissue-invasive CMV disease. In 7 patients with CMV DNAemia, the CD38(high)/CD3(+)8(+) T lymphocyte percentage did not exceed 20%, and these patients did not develop CMV infection requiring antiviral treatment. In 23 additional patients, a CD38(high)/CD3(+)CD8(+) percentage above 20% was recorded without CMV DNAemia. All of the remaining 234 patients never exceeded the arbitrary limit of 20%. The estimated sensitivity and specificity were 100% and 91% using clinical decision on the presence of CMV infection as a reference value, respectively. The estimated negative predictive value was 100%; however, the estimated positive predictive value was quite low (34%). CONCLUSIONS: The CD38(high)/CD3(+)8(+) lymphocyte percentage seems to be a useful additional diagnostic marker for CMV infection in patients after kidney transplantation, especially when patients are in the risk of a tissue-invasive disease when CMV DNA copies may not be detectable in peripheral blood.

Centre for Cardiovascular Surgery and Transplantation Brno Brno Czech Republic

Department of Clinical Immunology and Allergology St Anne's Faculty Hospital Masaryk University Brno Czech Republic

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