Enter Note
D163 - Implementing a CMV T-cell Immunity Panel Guided Prophylaxis Protocol is Safe
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Author Block: S. Metwally1, D. Jain2, R. Sodhi2, V. Peev2, S. Akkina2, 1Henry Ford Hospital, Detroit, MI, 2Loyola University Medical Center, Maywood, IL
*Purpose: The aim of this study is to demonstrate the safety of implementing a T-cell immunity panel (TCIP) based protocol to guide CMV prophylaxis.
*Methods: We performed a retrospective review of all CMV seropositive kidney transplant recipients transplanted at our institution from 1/1/2021 to 3/31/2025. Beginning 8/1/2023 we utilized TCIP on all CMV seropositive kidney transplant recipients. Those with a positive result, defined by a CD4 >/= 0.2%, underwent early valganciclovir discontinuation at 3 months post-transplant rather than the institutional protocol of 6 months. We compared the characteristics and outcomes of patients completing TCIP with a historical control at our center from 1/1/2021-7/31/2023 who did not undergo TCIP. The outcomes compared were CMV viremia, leukopenia and need for filgrastim.
*Results: In total, 169 patients who underwent TCIP at 3 months were compared to a historical control group of 448 patients who did not complete TCIP. Demographic and clinical characteristics were largely similar between the groups (Table 1). The TCIP group was more likely to receive anti-thymocyte globulin (ATG) for induction immunosuppression (87.6%) than the control group (76.6%, p= 0.02) (Table 2). Both groups developed CMV viremia (10.1% vs 12.5%, p=0.40) and leukopenia (55.0% vs 57.4%, p=0.60) at similar rates. The intervention group received filgrastim at a higher rate (30.8% vs 14.5%, p<0.001), even if restricted to the thymoglobulin induction group only (Table 3).
*Conclusions: Utilizing a TCIP based protocol did not increase the risk for CMV viremia or leukopenia. As the degree of leukopenia remained similar, the greater need for filgrastim likely reflects a change in practice at our institution.
| Control | TCIP | Total | p-value | |
| n | 448 (72.6%) | 169 (27.4%) | 617 | |
| Age | 53.05 (12.69) | 53.99 (12.52) | 53.31 (12.64) | 0.410 |
| Male | 274 (61.2%) | 107 (63.3%) | 381 (61.8%) | 0.624 |
| Diabetes | 226 (50.4%) | 97 (57.4%) | 323 (52.4%) | 0.123 |
| Dialysis_Pre_Txp | 289 (77.9%) | 128 (85.9%) | 417 (80.2%) | 0.038 |
| Thymoglobulin | 343 (76.6%) | 148 (87.6%) | 491 (79.6%) | 0.002 |
| Control | TCIP | Total | p-value | |
| n | 448 (72.6%) | 169 (27.4%) | 617 | |
| CMV>500IU/ml | 56 (12.5%) | 17 (10.1%) | 73 (11.8%) | 0.403 |
| CMV_Disease | 7 (13.5%) | 5 (19.2%) | 12 (15.4%) | 0.506 |
| WBC_Minimum | 2.55 (1.31) | 2.53 (1.25) | 2.55 (1.30) | 0.836 |
| Leukopenia | 257 (57.4%) | 93 (55.0%) | 350 (56.7%) | 0.601 |
| Filgrastim | 65 (14.5%) | 52 (30.8%) | 117 (19.0%) | <0.001 |
| Filgrastim_Doses | 0.50 (1.72) | 1.07 (2.36) | 0.66 (1.93) | 0.001 |
| Control | TCIP | Total | p-value | |
| n | 343 (69.9%) | 148 (30.1%) | 491 | |
| CMV>500IU/ml | 51 (14.9%) | 16 (10.8%) | 67 (13.6%) | 0.229 |
| CMV_Disease | 7 (14.6%) | 5 (20.0%) | 12 (16.4%) | 0.553 |
| WBC_Minimum | 2.40 (1.22) | 2.51 (1.19) | 2.44 (1.21) | 0.352 |
| Leukopenia | 211 (61.5%) | 80 (54.1%) | 291 (59.3%) | 0.123 |
| Filgrastim | 50 (14.6%) | 46 (31.1%) | 96 (19.6%) | <0.001 |
| Filgrastim_Doses | 0.55 (1.89) | 0.99 (2.25) | 0.69 (2.01) | 0.026 |