Risk factors and clinical outcomes of cytomegalovirus disease occurring more than one year post solid organ transplantation

Blyth, Dana M; Lee, I.; Sims, Karen; Gasink, Leanne B.; Barton, Todd D.; Deerlin, V. M. Van; Pfeiffenberger, Patrice; Blumberg, Emily A.

doi:10.1111/j.1399-3062.2011.00705.x

Cited by 27 publications

(50 citation statements)

References 18 publications

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“…Significant research has been devoted to the prevention of CMV disease after kidney transplantation, and CMV-seronegative recipients of organs from CMV-seropositive donors (D+/R−), as well as CMV-seropositive transplant recipients (R+) in the United States now generally receive prophylactic anti-CMV therapy for at least 3 months post-transplant (3;10–14). This however has led to the emergence of delayed-onset CMV disease, typically categorized as either late-onset CMV disease (occurring between discontinuation of anti-CMV prophylaxis and 1 year post-transplant) (13;15–19), or very late-onset CMV disease (occurring more than 1 year post-transplant) (19–21). …”

Section: Introductionmentioning

confidence: 99%

Delayed-Onset Cytomegalovirus Disease Coded During Hospital Readmission After Kidney Transplantation

et al. 2014

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Background Use of prophylactic anti-CMV therapy for 3 to 6 months after kidney transplantation can result in delayed-onset CMV disease. We hypothesized that delayed-onset CMV disease (occurring ≥ 100 days post-transplant) occurs more commonly than early-onset CMV disease, and that it is associated with death. Methods We assembled a retrospective cohort of 15,848 adult kidney transplant recipients using 2004 to 2010 administrative data from the California and Florida Healthcare Cost and Utilization Project State Inpatient Databases. We identified demographic data, comorbidities, CMV disease coded during readmission and inpatient death. We used multivariate Cox proportional hazards modeling to determine risk factors for delayed-onset CMV disease and inpatient death. Results Delayed-onset CMV disease was identified in 4.0% and early-onset CMV disease was identified in 1.2% of the kidney transplant recipients. Risk factors for delayed-onset CMV disease included previous transplant failure or rejection (HR 1.4) and residence in the lowest-income ZIP codes (HR 1.2). Inpatient death was associated with CMV disease occurring 101–365 days post-transplant (HR 1.5), CMV disease occurring > 365 days post-transplant (HR 2.1), increasing age (by decade: HR 1.5), non-white race (HR 1.2), residence in the lowest-income ZIP codes (HR 1.2), transplant failure or rejection (HR 3.2), prior solid organ transplant (HR 1.7) and several comorbidities. Conclusions These data showed that delayed-onset CMV disease occurred more commonly than early-onset CMV disease, and that transplant failure or rejection is a risk factor for delayed-onset CMV disease. Further research should be done to determine if delayed-onset CMV disease is independently associated with death.

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Section: Introductionmentioning

confidence: 99%

Delayed-Onset Cytomegalovirus Disease Coded During Hospital Readmission After Kidney Transplantation

et al. 2014

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“…Entre las manifestaciones clínicas de la enfermedad por CMV se encuentra comúnmente la gastrointestinal en pacientes con posterioridad a trasplante de órganos sólidos 29,30 ; similar situación se presenta en los trasplantes de corazón 31 . En nuestra serie, un paciente de los dos que desarrollaron la enfermedad tuvo un compromiso gastrointestinal manifestado por dolor abdominal difuso y deposiciones acuosas.…”

Section: Discussionunclassified

Enfermedad por citomegalovirus en pacientes receptores de trasplante de corazón en un centro de referencia nacional

Rojas-Contreras

Cruz-Ku

Valcárcel

2016

Rev. chil. infectol.

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Introduction: Heart transplantation remains as the treatment of choice when the heart failure is refractory to the medical or surgical therapy. Therefore, cytomegalovirus disease is an important post-heart-transplant infectious complication. Aims: To describe the prevalence and clinical characteristics of the cytomegalovirus disease after heart transplant surgery. Materials and Methods: A retrospective, descriptive study was conducted. It enrolled 35 heart-transplant patients attended in the Cardiovascular National Institute (INCOR), between 2010 and 2015. The information was obtained through the review of medical records. The demographic and relevant clinical variables were analyzed for the cytomegalovirus disease cases. Results: The population mean age was 39.49 ± 15.07 years and most of them were male patients (63%). The prevalence of the cytomegalovirus disease was 5.7% (two patients), both were seronegative for cytomegalovirus before transplantation. One of the patients had the disease before finishing the valganciclovir prophylaxis and the other after the end of it. Conclusion: The prevalence of the cytomegalovirus disease is slightly lower than in other studies. Moreover, the cytomegalovirus disease can remit with a prompt diagnosis and the proper medical treatment.

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“…Physicians may be more likely to document tissue-invasive CMV disease and CMV syndrome in the medical record due to the severity of CMV disease and its deleterious impact on allograft and patient survival (7,13). …”

Section: Discussionmentioning

confidence: 99%

“…CMV prophylaxis administered for 3 to 6 months post-transplant to CMV-seronegative recipients of kidneys from CMV-seropositive donors and CMV-seropositive recipients has decreased the incidence of active CMV infection and disease early after transplantation (4–6). However, delayed-onset CMV disease can occur after stopping prophylaxis (7–13), and is associated with an increased risk of death (7,13–15). No national surveillance system for active CMV infection or disease exists, thereby limiting our ability to compare the real-world effectiveness of different CMV prevention strategies used by kidney transplant centers in the United States.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of Inpatient International Classification of Diseases, Ninth Revision, Clinical Modification Coding for Cytomegalovirus After Kidney Transplantation

Santos

Brennan

Olsen

2015

Transplantation Proceedings

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Background International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) coding for cytomegalovirus (CMV) has been used as a proxy for active CMV infection or disease occurring in the inpatient setting in retrospective studies of kidney transplant recipients using large administrative data. However, the accuracy of inpatient CMV coding has not been determined. Methods We identified 393 kidney transplant recipients who were readmitted to Barnes-Jewish Hospital in St. Louis, Missouri from January 1, 2007 to December 31, 2011 to determine the accuracy of the ICD-9-CM diagnosis code for CMV (078.5) in identifying active CMV infection or disease (asymptomatic viremia, CMV syndrome or tissue-invasive CMV disease) in the inpatient setting, using microbiologic, histopathologic or ophthalmologic evidence for CMV as the gold standard. Results The sensitivity and positive predictive value of CMV coding in identifying active CMV infection or disease were 0.77 and 0.71 respectively. The specificity and negative predictive value were both 0.98. The sensitivity of CMV coding in identifying CMV syndrome or tissue-invasive CMV disease was 0.93. Conclusions CMV coding had good accuracy in identifying active CMV infection or disease among readmitted kidney transplant recipients in our hospital. Further validation studies of CMV coding in other hospitals are needed to obtain more generalizable estimates of the accuracy of CMV coding.

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Risk factors and clinical outcomes of cytomegalovirus disease occurring more than one year post solid organ transplantation

Cited by 27 publications

References 18 publications

Delayed-Onset Cytomegalovirus Disease Coded During Hospital Readmission After Kidney Transplantation

Delayed-Onset Cytomegalovirus Disease Coded During Hospital Readmission After Kidney Transplantation

Enfermedad por citomegalovirus en pacientes receptores de trasplante de corazón en un centro de referencia nacional

Accuracy of Inpatient International Classification of Diseases, Ninth Revision, Clinical Modification Coding for Cytomegalovirus After Kidney Transplantation

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