Etiology and impact of cytomegalovirus disease on solid organ transplant recipients

McDevitt, Lisa M.

doi:10.2146/ajhp060377

Cited by 38 publications

(26 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The increased likelihood of co-infection could merely represent the overall state of immunosuppression of the recipient or may be the result of the immunosuppressive effects of CMV and EBV (24–26). Or it could mean that some individuals have certain Class-1 HLA-antigens responsible for presenting virus to CD8+ lymphocytes that are less effective in presenting some viral antigens than others.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Donor Viral Replication at Transplant on Recipient Infections Posttransplant

et al. 2015

View full text Add to dashboard Cite

Background Organ donors are often implicated as the source of posttransplant recipient infection. We prospectively studied kidney and liver donor-recipient pairs to determine if donor viral replication of cytomegalovirus (CMV), Epstein-Barr virus (EBV), and BK polyomavirus (BKV) at transplant was a risk factor for posttransplant recipient infection and disease. Methods Donors and recipients were studied for antibodies against CMV and EBV and for quantitative viral replication of CMV, EBV and BKV in oral washes, urine, and whole blood pretransplant. Recipient testing continued every 3 months posttransplant. Demographic and clinical data on infections and graft and subject outcomes were obtained. Results The 98 donor-recipient pairs included 15 liver and 83 kidney transplants (18 of whom were children). No donor had detectable CMV replication; therefore its impact on recipient CMV replication could not be analyzed. Donor EBV replication occurred in 22%, mostly in the oral wash and had no impact on posttransplant recipient EBV replication (p 0.9) or EBV viremia (p 0.6) in kidney or liver recipients. Donor BKV replication occurred in 17%, mostly in the urine and although not associated with posttransplant recipient urinary BKV replication in recipients, it was associated with BKV viremia (p 0.02), and a significantly shorter time to BKV viremia (p 0.01) in kidney recipients. Conclusion Donor replication of CMV or EBV did not impact posttransplant recipient viral replication in kidney/liver transplants. Donor urinary BKV replication is associated with recipient BKV viremia in kidney transplants.

show abstract

Section: Discussionmentioning

confidence: 99%

The Impact of Donor Viral Replication at Transplant on Recipient Infections Posttransplant

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Indirect effects are also clinically significant. CMV infection is associated with an increased risk of acute rejection and secondary infections . Of particular concern is evidence that CMV infection may promote the development of cardiac allograft vasculopathy (CAV), a leading cause of death after the first post‐transplant year .…”

Section: Introductionmentioning

confidence: 99%

Diminished impact of cytomegalovirus infection on graft vasculopathy development in the antiviral prophylaxis era - a retrospective study

et al. 2018

View full text Add to dashboard Cite

Evidence concerning an association between cytomegalovirus (CMV) infection and accelerated cardiac allograft vasculopathy (CAV) is inconclusive. Data were analyzed retrospectively from 297 consecutive heart transplants between 1.1.2002 and 31.12.2012. Patients ≤18 years of age, survival, and follow-up ≤1-year post-transplant and patients with early CAV were excluded. CMV-infection was diagnosed and monitored closely in the first year. CAV was diagnosed by coronary angiography via left heart catheterization, and results were categorized according to the International Society of Heart and Lung Transplantation (ISHLT) scoring system. Risk factors for CAV were tested in a multivariable model. Median follow-up was 7.5 years (IQR: 5.6-10.3). CMV infection in the first year after transplantation occurred in 26% of patients (n = 78), CMV disease in 5% (n = 15). CAV ≥1 ISHLT was detected in 36% (n = 108). Incidence of CAV >1 ISHLT and severity of CAV increased over time. No statistically significant association between CMV infection and disease within the first year and risk of CAV after 1-year post-HTx was detected in the univariate (P = 0.16) and multivariable [hazard ratio (HR), 1.36; confidence interval (CI), 0.89-2.07; P = 0.16] Cox regression. In the multivariable Cox regression, donor age (HR, 1.04; 95% CI, 1.02-1.06; P < 0.01) and acute cellular rejection (ACR) ≥2R in the first year after HTx (HR, 1.77; 95% CI, 1.06-2.95; P = 0.03) were independent risk factors for CAV development. In our cohort, CMV infection and disease in the first year after transplantation did not significantly influence the risk of CAV in the long-term follow-up.

show abstract

“…Therefore, oral CMV prophylaxis is usually given for the first 3 months after transplantation. Late-onset CMV infection, occurring after the discontinuation of prophylaxis, has emerged as a problem in recent years [10]. It is thought to be due to the use of a potent antiviral agent for a prolonged period, which inhibits the development of long-term protective immunity against CMV [11].…”

Section: Introductionmentioning

confidence: 99%

Late-onset CMV disease following CMV prophylaxis

et al. 2009

View full text Add to dashboard Cite

show abstract

Etiology and impact of cytomegalovirus disease on solid organ transplant recipients

Abstract: Knowledge of risk factors for CMV infection and disease, the natural history in transplant recipients, and its direct and indirect effects will help clinicians make appropriate decisions regarding the use of preventive strategies.

Cited by 38 publications

References 44 publications

The Impact of Donor Viral Replication at Transplant on Recipient Infections Posttransplant

The Impact of Donor Viral Replication at Transplant on Recipient Infections Posttransplant

Diminished impact of cytomegalovirus infection on graft vasculopathy development in the antiviral prophylaxis era - a retrospective study

Late-onset CMV disease following CMV prophylaxis

Contact Info

Product

Resources

About