Suárez Fernández, PatriciaUtrero Rico, AlbertoSandonis, VirginiaGarcía Ríos, EstéfaniArroyo Sánchez, DanielFernández Ruiz, MarioAndrés, Amado dePolanco, NataliaGonzález Cuadrado, CeciliaAlmendro Vazquez, PatriciaPérez Romero, PilarAguado, José MaríaPaz Artal, EstelaLaguna Goya, Rocío2023-06-172023-06-172021-06-211600-613510.1111/ajt.16725https://hdl.handle.net/20.500.14352/6829CRUE-CSIC (Acuerdos Transformativos 2021)Primary infection and/or reactivation of cytomegalovirus (CMV) in kidney transplant recipients (KTR) favor rejection and mortality. T follicular helper cells (TFH) could contribute to protection against CMV. Circulatory TFH (cTFH) were studied pretransplant and early posttransplant in 90 CMV seropositive KTR not receiving antithymocyte globulin or antiviral prophylaxis, followed-up for 1 year. Patients who presented CMV infection had significantly lower cTFH and activated cTFH pretransplant and early posttransplant. Pretransplant activated cTFH were also lower within patients who developed CMV disease. Pre- and 14 days posttransplant activated cTFH were an independent protective factor for CMV infection (HR 0.41, p = .01; and 0.52, p = .02, respectively). KTR with low cTFH 7 days posttransplant (<11.9%) had lower CMV infection-free survival than patients with high cTFH (28.2% vs. 67.6%, p = .002). cTFH were associated with CMV-specific neutralizing antibodies (Nabs). In addition, IL-21 increased interferon-γ secretion by CMV-specific CD8+ T cells in healthy controls. Thus, we show an association between cTFH and lower incidence of CMV infection, probably through their cooperation in CMV-specific Nab production and IL-21-mediated enhancement of CD8+ T cell activity. Moreover, monitoring cTFH pre- and early posttransplant could improve CMV risk stratification and help select KTR catalogued at low/intermediate risk who could benefit from prophylaxis.engAtribución 3.0 Españajournal articlehttps://doi.org/10.1111/ajt.16725https://onlinelibrary.wiley.com/doi/10.1111/ajt.16725open accessbasic (laboratory) researchscienceflow cytometryimmunobiologyinfection and infectious agents- viralCytomegalovirus (CMV)infectious diseasekidney transplantationnephrologytranslational researchInmunologíaNefrología y urología2412 Inmunología