Association of HLA Class I Repertoire Score with Severity of Human Cytomegalovirus Infection in Transplant Patients.

Human Cytomegalovirus (HCMV) is a common herpesvirus that typically causes asymptomatic infection but can lead to severe complications in transplant patients due to reactivation. 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, despite the RS could not predict HCMV reactivation, transplant patients with infection had significantly higher HLA repertoire scores than those with disease (average RS = 1499.8 vs. 1115.3, P=0.001). The RS predicted HCMV outcomes with 78% sensitivity and 80% specificity. Notably, patients with an RS below 1329 had a 4.22-fold increased risk of developing HCMV disease post-transplant, suggesting RS as a valuable tool for clinical prognosis.