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Clinical predictors of progression and clearance of low‐level CMV DNAemia in solid organ transplant recipients
Author(s) -
Natori Yoichiro,
Alghamdi Ali,
Husain Shahid,
Rotstein Coleman,
Selzner Nazia,
Tikkanen Jussi,
Schiff Jeffrey,
Humar Atul,
Kumar Deepali
Publication year - 2020
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.13207
Subject(s) - medicine , viral load , odds ratio , clearance , cytomegalovirus , cohort , immunology , gastroenterology , viral disease , human immunodeficiency virus (hiv) , herpesviridae , urology
Background Low‐level CMV DNAemia is common and in the absence of treatment may either progress to higher viral loads that require therapy, or may spontaneously resolve. The clinical predictors of progression and spontaneous viral clearance are not well defined. Methods We performed a retrospective cohort study of organ transplant recipients who had untreated low‐level CMV DNAemia (<1000 IU/mL). Outcomes were evaluated for 8 weeks after initial viral detection, and progression to CMV high viral load was defined as CMV viral load ≥1000 IU/mL. CMV DNAemia doubling time was calculated for a subset of patients with sufficient viral load timepoints. Results Of the 297 patients analyzed, 118/297 (39.7%) patients progressed to a high viral load and the remaining cleared DNAemia spontaneously (46.8%) or remained at low level (13.4%). In multivariate analysis, progression was significantly more likely in lung transplant recipients (odds ratio 3.09) and less likely in those with an episode of previously treated CMV infection (odds ratio 0.081). In a subset of 27 patients with progression, the doubling time for CMV DNAemia was a median of 6.1 days (range 2.4‐21.8). Conclusion We found that previous CMV infection significantly decreased the likelihood of low‐level DNAemia progression suggesting that CMV immunity plays a role in progression vs spontaneous clearance.