Association of Human Leukocyte Antigen Class I Repertoire Score With Severity of Human Cytomegalovirus Infection in Patients Undergoing Transplantation.

Abstract

Human cytomegalovirus (HCMV) is a common herpesvirus that typically causes asymptomatic infection but can lead to severe complications due to reactivation in patients undergoing transplantation. The human leukocyte antigen (HLA) plays a crucial role in antigen presentation and T-cell activation, essential for an effective immune response. Understanding HLA-pathogen interactions can help predict susceptibility or resistance to infection. In this study, we explored the association between different HLA-I types and resistance to HCMV. We developed a repertoire score (RS) to assess each individual's antigen presentation capacity. Our findings showed that although the RS could not predict HCMV reactivation, patients with infection had significantly higher HLA RSs than those with disease (average RS, 1499.8 vs 1115.3; P = .001). The RS predicted HCMV outcomes with 78% sensitivity and 80% specificity. Notably, patients with an RS <1329 had a 4.22-fold increased risk of developing HCMV disease posttransplant, suggesting RS as a valuable tool for clinical prognosis.