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Functional Impairment of Cytomegalovirus Specific CD8 T Cells Predicts High‐Level Replication After Renal Transplantation

Human cytomegalovirus (HCMV) remains an important cause of morbidity after allotransplantation, causing a range of direct effects including hepatitis, pneumonitis, enteritis and retinitis. A dominant risk factor for HCMV disease is high level viral replication in blood but it remains unexplained why only a subset of patients develop such diseases. In this detailed study of 25 renal transplant recipients, we show that functional impairment of HCMV specific CD8 T cells in the production of interferon gamma was associated with a 14‐fold increased risk of progression to high level replication. The CD8 T‐cell impairment persisted during the period of high level replication and was more prominent in patients above 40 years of age (odds ratio = 1.37, p = 0.01) and was also evident in dialysis patients. Threshold levels of functional impairment were associated with an increased risk of future HCMV replication and there was a direct relationship between the functional capacity of HCMV ppUL83 CD8 T cells and HCMV load (R2= 0.83). These results help to explain why a subset of seropositive individuals develop HCMV replication and are at risk of end‐organ disease and may facilitate the early identification of individuals who would benefit from targeted anti‐HCMV therapy after renal transplantation.