Cytomegalovirus transmission in mismatched solid organ transplant recipients: Are factors other than anti-viral prophylaxis at play?
| Autor: | Cristina Hernandez, Curtis Mabilangan, Catherine Burton, Jutta K. Preiksaitis, Karen Doucette |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Congenital cytomegalovirus infection Cytomegalovirus Disease Antiviral Agents Gastroenterology Risk Factors Internal medicine Epidemiology medicine Humans Immunology and Allergy Pharmacology (medical) Seroconversion Ganciclovir Retrospective Studies Transplantation Kidney Lung Transmission (medicine) business.industry Incidence (epidemiology) virus diseases Organ Transplantation medicine.disease Transplant Recipients medicine.anatomical_structure Cytomegalovirus Infections business |
| Zdroj: | American Journal of Transplantation. 21:3958-3970 |
| ISSN: | 1600-6135 |
| DOI: | 10.1111/ajt.16734 |
| Popis: | Although antiviral prophylaxis has reduced cytomegalovirus (CMV) DNAemia and disease in seronegative solid organ transplant (SOT) recipients (R-) receiving seropositive donor organs (D+), its impact on CMV transmission is uncertain. Transmission, defined as CMV antigenemia/CMV DNAemia and/or seroconversion by year 2, and associated demographic risk factors were studied retrospectively in 428 D+/R- and 429 D-/R- patients receiving a SOT at our center. The cumulative transmission incidence was higher for lung (90.5%) and liver recipients (85.1%) than heart (72.7%), kidney (63.9%), and pancreas (56.2%) recipients (p .001) and was significantly lower in living (50.1%) versus deceased donor (77.4%, p .001) kidney recipients despite identical antiviral prophylaxis. In multivariate analysis, only allograft type predicted transmission risk (HR [CI] lung 1.609 [1.159, 2.234] and liver 1.644 [1.209, 2.234] vs kidney). For 53 D+ donating to1 R- with adequate follow-up, 43 transmitted to all, three transmitted to none, and seven transmitted inconsistently with lungs and livers always transmitting but donor-matched heart, kidney or kidney-pancreas allografts sometimes not. Kidney pairs transmitted concordantly. CMV transmission risk is allograft-specific and unchanged despite antiviral prophylaxis. Tracking transmission and defining donor factors associated with transmission escape may provide novel opportunities for more targeted CMV prevention and improve outcome analysis in antiviral and vaccine trials. |
| Databáze: | OpenAIRE |
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