Cytomegalovirus (CMV) Disease Despite Weekly Preemptive CMV Strategy for Recipients of Solid Organ and Hematopoietic Stem Cell Transplantation

Author:

Lodding I P1,da Cunha Bang C2,Sørensen S S3,Gustafsson F4,Iversen M5,Kirkby N6,Perch M5,Rasmussen A7,Sengeløv H2,Mocroft A8,Lundgren J D1

Affiliation:

1. Centre for Health, Immunity and Infectious Diseases (CHIP), Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark

2. Department of Haematology, Rigshospitalet, Copenhagen, Denmark

3. Department of Nephrology, Rigshospitalet, Copenhagen, Denmark

4. Department of Cardiology, Rigshospitalet, Copenhagen, Denmark

5. Department of Cardiology, Section for Lung Transplantation, Rigshospitalet, Copenhagen, Denmark

6. Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark

7. Abdominal Surgery, Rigshospitalet, Copenhagen, Denmark

8. Institute for Global Health, Infection and Population Health, University College of London, United Kingdom

Abstract

Abstract Background Transplant recipients presenting with cytomegalovirus (CMV) disease at the time of diagnosis of CMV DNAemia pose a challenge to a preemptive CMV management strategy. However, the rate and risk factors of such failure remain uncertain. Methods Solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT) recipients with a first episode of CMV polymerase chain reaction (PCR) DNAemia within the first year posttransplantation were evaluated (n = 335). Patient records were reviewed for presence of CMV disease at the time of CMV DNAemia diagnosis. The distribution and prevalence of CMV disease were estimated, and the odds ratio (OR) of CMV disease was modeled using logistic regression. Results The prevalence of CMV disease increased for both SOT and HSCT with increasing diagnostic CMV PCR load and with screening intervals >14 days. The only independent risk factor in multivariate analysis was increasing CMV DNAemia load of the diagnostic CMV PCR (OR = 6.16; 95% confidence interval, 2.09–18.11). Among recipients receiving weekly screening (n = 147), 16 (10.8%) had CMV disease at the time of diagnosis of CMV DNAemia (median DNAemia load 628 IU/mL; interquartile range, 432–1274); 93.8% of these cases were HSCT and lung transplant recipients. Conclusions Despite application of weekly screening intervals, HSCT and lung transplant recipients in particular presented with CMV disease at the time of diagnosis of CMV DNAemia. Additional research to improve the management of patients at risk of presenting with CMV disease at low levels of CMV DNAemia and despite weekly screening is warranted.

Funder

Danish National Research Foundation

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Oncology

Reference39 articles.

1. Infection in organ-transplant recipients;Fishman;N Engl J Med,1998

2. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective;Tomblyn;Biol Blood Marrow Transplant,2009

3. Definitions of cytomegalovirus infection and disease in transplant patients for use in clinical trials;Ljungman;Clin Infect Dis,2017

4. Pre-emptive treatment for cytomegalovirus viraemia to prevent cytomegalovirus disease in solid organ transplant recipients;Owers;Cochrane Database Syst Rev,2013

5. Updated international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation;Kotton;Transplantation,2013

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3