Differences of cytomegalovirus diseases between kidney and hematopoietic stem cell transplant recipients during preemptive therapy

Abstract

Background/Aims:Cytomegalovirus (CMV) surveillance and preemptive therapy is a widely-used strategy for preventing CMV disease in transplant recipients. However, there are limited data on the incidence and patterns of CMV disease during the preemptive period. Thus, we investigated the incidence and pattern of tissue-invasive CMV disease in CMV seropositive kidney transplantation (KT) and hematopoietic stem cell transplantation (HCT) recipients during preemptive therapy.Methods:We prospectively identified patients with tissue-invasive CMV disease among 664 KT (90%) and 496 HCT (96%) recipients who were D+/R+ (both donor and recipient seropositive) during a 4-year period.Results:The incidence rates of CMV disease were 4.1/100 person-years (4%, 27/664) in KT recipients and 5.0/100 person-years (4%, 21/496) in HCT recipients. Twenty-six (96%) of the KT recipients with CMV disease had gastrointestinal CMV, whereas 17 (81%) of the HCT recipients had gastrointestinal CMV and 4 (19%) had CMV retinitis. Thus, CMV retinitis was more common among HCT recipients (p = 0.03). All 27 KT recipients with CMV disease suffered abrupt onset of CMV disease before or during preemptive therapy; 10 (48%) of the 21 HCT recipients with CMV disease were also classified in this way but the other 11 (52%) were classified as CMV disease following successful ganciclovir preemptive therapy (p < 0.001).Conclusions:The incidence of CMV disease was about 4% in both KT and HCT recipients during preemptive therapy. However, CMV retinitis and CMV disease as a relapsed infection were more frequently found among HCT recipients.

Diagnostic usefulness of the cytomegalovirus (CMV)-specific T cell-based assay for predicting CMV infection after kidney transplant

“…In addition, because of the high frequency of CMV seropositivity (> 95%) of Korean adults [4], most Korean SOT recipients are classified as at moderate risk of CMV infection. In our previous study, post-transplant CMV disease occurred in 5% of such KT recipients at moderate risk of CMV infection, despite of CMV antigenemia-based preemptive therapy [11]. In this clinical situation, a further risk stratification strategy is essen-tial if we wish to reduce CMV development after SOT.…”

Epidemiology and risk factors associated with Pneumocystis jirovecii pneumonia in kidney transplant recipients after 6‐month trimethoprim‐sulfamethoxazole prophylaxis: A case‐control study

“…A preemptive therapy has been used in seropositive KTRs since May 2009. Universal oral ganciclovir prophylaxis for 3 monthswas also employed in KTRs where the donor was seropositive and the recipient seronegative 9,11.…”

“…Median time from transplant to CMV infection was 2.2 months (IQR 1.7-3.6), time from transplant to rejection 5.0 months (IQR 0.6-25.0). Time to PCP development after rejection (median [IQR], 6[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] months) was slightly shorter than after CMV infection (median [IQR], 9[5][6][7][8][9][10][11][12]), although this difference was not statistically significant (P = .18) (Table 3,…”

Sensitivity of the Cytomegalovirus Antigenemia Assay to Diagnose Cytomegalovirus Retinitis

“…Furthermore, CMV antigenemia has a lower sensitivity than CMV PCR. However, in the light of previous results, it can be assumed that the use of PCR would not have yielded very different results [11]. Third, because patients who did not have CMV antigenemia assay results were excluded from the study population, there may have been some selection bias.…”

“…In patients who underwent HCT, CMV antigenemia assays were performed weekly from day 21 to day 100 post-HCT, then monthly until one year after HCT [11]. Surveillance testing using the CMV antigenemia assay in patients with other underlying diseases was performed at the discretion of the attending physician.…”