QuantiFERON-CMV as a Predictor of CMV Events During Preemptive Therapy in CMV-seropositive Kidney Transplant Recipients

Transplantation. 2024 Apr 1;108(4):985-995. doi: 10.1097/TP.0000000000004870. Epub 2023 Nov 22.


Background: Prevention of cytomegalovirus (CMV) infection after kidney transplantation is costly and burdensome.

Methods: Given its promising utility in risk stratification, we evaluated the use of QuantiFERON-CMV (QFCMV) and additional clinical variables in this prospective cohort study to predict the first clinically significant CMV infection (CS-CMV, ranging from asymptomatic viremia requiring treatment to CMV disease) in the first posttransplant year. A cost-effectiveness analysis for guided prevention was done.

Results: One hundred adult kidney transplant recipients, CMV IgG + , were given basiliximab induction and maintained on steroid/mycophenolate/tacrolimus with weekly CMV monitoring. Thirty-nine patients developed CS-CMV infection (viral syndrome, n = 1; end-organ disease, n = 9; and asymptomatic viremia, n = 29). A nonreactive or indeterminate QFCMV result using the standard threshold around day 30 (but not before transplant) was associated with CS-CMV rates of 50% and 75%, respectively. A higher QFCMV threshold for reactivity (>1.0 IU interferon-γ/mL) outperformed the manufacturer's standard (>0.2 IU interferon-γ/mL) in predicting protection but still allowed a 16% incidence of CS-CMV. The combination of recipient age and type of donor, along with posttransplant QFCMV resulted in a prediction model that increased the negative predictive value from 84% (QFCMV alone) to 93%. QFCMV-guided preemptive therapy was of lower cost than preemptive therapy alone ( P < 0.001, probabilistic sensitivity analysis) and was cost-effective (incremental net monetary benefit of 210 USD) assuming willingness-to-pay of 2000 USD to avoid 1 CMV disease.

Conclusions: Guided CMV prevention by the prediction model with QFCMV is cost-effective and would spare from CMV surveillance in 42% of patients with low risk for CS-CMV.

MeSH terms

  • Adult
  • Antiviral Agents / therapeutic use
  • Cytomegalovirus
  • Cytomegalovirus Infections* / diagnosis
  • Cytomegalovirus Infections* / drug therapy
  • Cytomegalovirus Infections* / prevention & control
  • Humans
  • Interferon-gamma
  • Kidney Transplantation* / adverse effects
  • Prospective Studies
  • Transplant Recipients
  • Viremia / epidemiology


  • Antiviral Agents
  • Interferon-gamma