Survey on Transfusion-Transmitted Cytomegalovirus and Cytomegalovirus Disease Mitigation

Abstract

Context.— Cytomegalovirus (CMV) can be transmitted by cellular blood products, leading to severe disease in immunosuppressed patients such as neonates and transplant recipients. To mitigate transfusion-transmitted CMV (TT-CMV), “CMV-safe” blood products (leukoreduced and/or CMV-seronegative) are transfused. Attempts to develop practice guidelines for TT-CMV mitigation have been limited by paucity of high-quality clinical trials. Objective.— To assess current TT-CMV mitigation strategies across medical institutions for specific at-risk populations. Design.— Supplemental questions regarding TT-CMV and CMV disease mitigation were added to a College of American Pathologists Transfusion Medicine (Comprehensive) Participant Survey in 2015, addressing whether a given institution provided CMV-safe products for 6 at-risk patient populations. Results.— Ninety percent (2712 of 3032) of institutions reported providing universally leukoreduced blood products. Among institutions without universal leukoreduction, 92% (295 of 320) provided leukoreduced products on the basis of clinical criteria. Eighty-three percent (2481 of 3004) of respondents reported having availability of CMV-seronegative products; however, wide variation in policies was reported governing CMV-seronegative product use. Among all respondents, less than 5% reported using CMV prophylaxis and monitoring in high-risk patient groups. Transplant centers reported higher rates of CMV prophylaxis (25% [97 of 394] solid organ) and monitoring (15% [59 of 394] solid organ) for CMV-negative transplant recipients. Conclusions.— Universal leukoreduction is the primary strategy for mitigating TT-CMV. While most institutions have both CMV-seronegative and leukoreduced blood products available, consensus is lacking on which patients should receive these products. High-quality studies are needed to determine if CMV-seronegative and leukoreduced blood products are needed in high-risk patient populations.

Transfusion-transmitted and community-acquired cytomegalovirus infection in seronegative solid organ transplant recipients receiving seronegative donor organs

“…In the United States, a 2017 survey reported 90% of responding institutions use leukoreduction as the primary TT-CMV prevention strategy; 40% of respondents indicated that seronegative blood use was by physician discretion in the absence of clinical guidelines. 27 Given the TT-CMV observations in our study and those in HSCT populations, [19][20][21][22][23] discontinuation of use of seronegative blood products for SOT recipients provides an evidence-based opportunity for transfusion cost reduction in settings where leukoreduced blood products are already being given. This may be further justified when the risk of TT-CMV is compared to the high incidence of donor-derived CMV and CMV reactivation when donors or recipients are seropositive; the latter risks are considered acceptable when managed using antiviral drugs and laboratory surveillance strategies.…”

“…After reviewing data from this study along with other available evidence, 26 a decision was made in Canada to no longer perform additional screening for seronegative blood except to maintain an inventory for rare intrauterine transfusion. In the United States, a 2017 survey reported 90% of responding institutions use leukoreduction as the primary TT‐CMV prevention strategy; 40% of respondents indicated that seronegative blood use was by physician discretion in the absence of clinical guidelines 27 . Given the TT‐CMV observations in our study and those in HSCT populations, 19‐23 discontinuation of use of seronegative blood products for SOT recipients provides an evidence‐based opportunity for transfusion cost reduction in settings where leukoreduced blood products are already being given.…”

Things We Do for No Reason™: Routinely Prescribing Transfusion Premedication to Prevent Acute Transfusion Reactions

“…11 A recent large, national survey demonstrated 90% of institutions (2,712/3,032) use universal leukoreduction. 12 This widely employed and effective prevention strategy has likely helped reduce FNHTRs nationwide, so there are now fewer to prevent. 12 Irradiation is another common modification of blood components used to prevent transfusion-associated graft-vshost-disease (TA-GVHD) for recipients with significantly compromised cellular immunity.…”

“…12 This widely employed and effective prevention strategy has likely helped reduce FNHTRs nationwide, so there are now fewer to prevent. 12 Irradiation is another common modification of blood components used to prevent transfusion-associated graft-vshost-disease (TA-GVHD) for recipients with significantly compromised cellular immunity. TA-GVHD is a rare but nearly universally fatal delayed complication of transfusion.…”

Insight for Immunotherapy of HCMV Infection

“…A recent systematic review and meta-analysis estimated a global HCMV seroprevalence of 83% in the general population, 86% in women of reproductive age, and 86% in donors of organs or blood [3]. HCMV can be transmitted through motherto-child transmission; horizontal transmission; hospital-acquired respiratory, neurological, blood, and digestive system diseases; and other multi-system diseases, resulting in fetal malformation, birth defects [4], or poor prognosis of transplant patients with low immunity [5][6][7][8]. Following the establishment of infection, HCMV is usually latent (with only a few virus particles being released outside the cell), and the infected persons remain asymptomatic and become lifelong infectious carriers [9].…”