HLA-DRw6 as a risk factor for active cytomegalovirus but not for herpes simplex virus infection after renal allograft transplantation.

Roenhorst, H W; Tegzess, A. M.; Beelen, Josée M.; Middeldorp, J.M.; The, T. H.

doi:10.1136/bmj.291.6496.619

Cited by 18 publications

(9 citation statements)

References 20 publications

(2 reference statements)

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“…disease 43 + 19 REU. These differences are not statistically Like Roenhorst et al [17], we also found an increased risk of significant. In all CMV-negative recipients IgG anti-CMV was CMV infection when donor and/or patient had the HLA-DRw6 negative shortly after Tx. phenotype.…”

Section: Introductionsupporting

confidence: 37%

Factors influencing the occurrence of active cytomegalovirus (CMV) infections after organ transplantation

Boland¹,

Hené²,

Ververs³

et al. 1993

Clinical and Experimental Immunology

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SUMMARYIn this study, several factors influencing the occurrence of active CMV infection after organ transplantation (Tx) are analysed. For this purpose, 105 heart, kidney and lung transplant recipients who were CMV-positive or had a CMV-positive donor, were closely monitored for active CMV infection by antigenaemia, cultures, CMV serology and lymphocyte proliferation (LP) to CMV. Univariate and multivariate regression analysis were performed. As pretransplant risk factors the HLA-type and numbers of HLA mismatches between recipients and their donors, and the CMV serology of the recipient and donor were analysed. A new finding was that recipients of donors positive for HLA-B7 were especially at risk for developing active CMV infection (P= 0 03) and CMV disease (P= 0-03). This was not due to increased rejection treatment in these patients. Post-transplant risk factors for development ofactive CMV infection were absence ofdetectable cellular immunity to CMV (lymphocyte proliferation) after Tx (P< 001) and rejection treatment with OKT3 or ATG (P = 0-05). High levels of IgG anti-CMV did not prevent occurrence ofactive CMV infection or CMV disease in the CMV+ recipients.

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Section: Introductionsupporting

confidence: 37%

Factors influencing the occurrence of active cytomegalovirus (CMV) infections after organ transplantation

Boland¹,

Hené²,

Ververs³

et al. 1993

Clinical and Experimental Immunology

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“…We and others have observed variations in the incidence, severity, and consequences of viral activity in solid organ transplantation related to HLA matching (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). Several authors have observed that the incidence of CMV disease was more common when certain HLA antigens were present (3,6 -8,10 -13).…”

mentioning

confidence: 99%

Cytomegalovirus Disease after Prophylaxis with Oral Ganciclovir in Renal Transplantation

Lowell

Hmiel

Hardinger

et al. 2003

Journal of the American Society of Nephrology

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Abstract. This study assessed the incidence of cytomegalovirus (CMV) disease and associated outcomes after oral ganciclovir prophylaxis in renal transplantation. A retrospective analysis was performed of all adult renal transplant recipients at a single transplant center transplanted between August 16, 1996, and December 31, 2000. CMV disease prophylaxis included ganciclovir 1000 mg orally thrice daily prescribed for 90 d in DϪ/Rϩ cases and 180 d in Dϩ/RϪ and Dϩ/Rϩ cases. Forty (9.1%) of 470 patients studied were diagnosed with CMV disease, which varied significantly by CMV serostatus and number of HLA-DR matches. The highest incidence of disease, 26.2%, was in Dϩ/RϪ patients with zero HLA-DR matches. Five-year graft survival was 56.8% with CMV disease compared with 79.1% without (P Ͻ 0.001). Five-year graft survival with CMV disease was 75.9% with one or two HLA-DR matches versus 16.2% with zero HLA-DR matches (P Ͻ 0.001). CMV remains an important factor in long-term graft survival after oral ganciclovir prophylaxis. However, we have observed that the adverse impact of CMV disease on graft survival is apparent only in patients with zero HLA-DR matches. These results call for the development of new CMV disease prophylaxis and treatment strategies in patients with zero HLA-DR matches. In addition, organ allocation policies discouraging combining CMV-seropositive donors and zero HLA-DR matches may be worth consideration.In a study performed at our transplant center, we demonstrated the efficacy of oral ganciclovir prophylaxis to reduce the incidence of CMV viremia and symptomatic CMV disease in renal transplant recipients (1). CMV viremia was reduced from 100% in untreated patients to 11% in treated patients during prophylaxis. Overall symptomatic CMV disease incidence was 61% in untreated patients and 21% in patients treated with oral ganciclovir prophylaxis after the completion of a 3-mo prophylaxis regimen. Although the incidence of symptomatic CMV disease was significantly reduced by prophylaxis, it was remarkable that disease occurred more commonly when the donor was CMV-seropositive compared with seronegative. We subsequently extended our prophylaxis to 90 d in D -/Rϩ cases and 180 d in Dϩ/RϪ and Dϩ/Rϩ cases. The long-term consequences of the CMV disease that did occur were unknown.We and others have observed variations in the incidence, severity, and consequences of viral activity in solid organ transplantation related to HLA matching (2-16). Several authors have observed that the incidence of CMV disease was more common when certain HLA antigens were present (3,6 -8,10 -13). We have observed that certain matched and mismatched HLA antigens are associated with increased graft loss rates from CMV sero-mismatching (2).To determine the long-term impact of short term oral ganciclovir prophylaxis, the development of CMV disease, and the impact of donor and recipient HLA matching, we have undertaken a retrospective review of the outcomes of patients treated at our center with a uniform oral ganciclovir CMV-proph...

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“…Roenhorst et al (1985) found that cadaveric renal transplant recipients positive for HLA-DRw6, compared to those negative for this antigen, showed a significantly earlier and higher frequency of CMV infection detected serologically. No relationship to any other HLA antigens were found, including A and B antigens.…”

Section: Cytomegalovirus Lnfection Graft Rejection and Allograft Rementioning

confidence: 85%

Cytomegalovirus

1991

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All rights reserved 90-14345 CIP No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher Preface to the First EditionAlthough there are a number of excellent current reviews on one or another aspect of cytomegalovirus, the last comprehensive treatment of this subject was that of Krech et al. (197la). In view of the amazing advances in the virological, epidemiologic, and clinical knowledge of cytomegaloviruses, an up-to-date book is needed. Such a work should cover many areas of expertise and a voluminous technical literature. Each area might have been reviewed and analyzed by workers more expert than myself. However, I have embarked on the entire venture alone in order to attain unity and continuity in this book, characteristics that are not easily achieved in the more popular multiauthored works. I have tried to review the Iiterature and provide a critical summary for each area discussed. To do this, I provide as much of the primary data of the relevant works as needed and not just the qualitative conclusions. Inevitably, the flow of the narrative may be interrupted by dry facts and figures. However, such information is essential to make this a meaningful reference work. But for those not interested in such details, I have provided at what I hope are crucial points critiques and summaries.This book is not an exhaustive review of all the literature. This is probably no Ionger possible or even desirable. By selection, however, one runs the risk of having missed or ignored important papers. I am keenly aware of this, and I wish to apologize for such oversight, if that is possible.I visualize this work as being useful for physicians, scientists, and students interested in the biology of and infection by human cytomegalovirus. I feel that to understand these, the basic virology of this virus and related herpesviruses must be included. Topics that have not advanced a great deal and that are adequately described in available works, such as the anatomic pathology, have not been reviewed in detail. The emphasis has been placed on newer insights in the virology, immunology, serology, epidemiology, and especially clinical aspects of human cytomegalovirus. I wish tobring out the interactions of knowledge in these areas. Part II is a much shorter treatment of the nonhuman cytomegaloviruses, reviewed primarily from the point of view of their contribution to the understanding of the human virus. V vi Preface to the First Edition Finally, I wish to thank Drs. Charles R. Rinaldo, Jr., John A. Armstrong, and Donald N. Medearis for their critical review of the manuscript. Their suggestions were invaluable. Dr. John N. Dowling's thorough review of CMV infection in patients with malignancies was the basis of Section 13.4. I also acknowledge the indispensable and patient secretarial assistance of Ms.The remarkable medical events and advances in knowle...

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HLA-DRw6 as a risk factor for active cytomegalovirus but not for herpes simplex virus infection after renal allograft transplantation.

Abstract: To study genetically determined susceptibility to cytomegalovirus and herpes simplex virus infections in patients given renal transplants a prospective study was

Cited by 18 publications

References 20 publications

Factors influencing the occurrence of active cytomegalovirus (CMV) infections after organ transplantation

Factors influencing the occurrence of active cytomegalovirus (CMV) infections after organ transplantation

Cytomegalovirus Disease after Prophylaxis with Oral Ganciclovir in Renal Transplantation

Cytomegalovirus

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