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Unknown cytomegalovirus serostatus in primary immunodeficiency disorders: A new category of transplant recipients
Author(s) -
Forlanini Federica,
Dara Jasmeen,
Dvorak Christopher C.,
Cowan Morton J.,
Puck Jennifer M.,
Dorsey Morna J.
Publication year - 2021
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.13504
Subject(s) - serostatus , medicine , incidence (geometry) , primary immunodeficiency , cytomegalovirus , hematopoietic stem cell transplantation , viremia , immunology , antibody , gastroenterology , transplantation , human immunodeficiency virus (hiv) , immune system , viral disease , viral load , herpesviridae , physics , optics
Background Cytomegalovirus (CMV) serostatus of recipient (R) and donor (D) influences hematopoietic stem cell transplant (HSCT) outcome. However, it is not a reliable indicator of CMV infection in primary immunodeficiency disorder (PIDD) recipients who are unable to make adequate antigen‐specific immunoglobulin (Ig) or who receive intravenous Ig (IVIg) prior to testing. Objective Since no data exist on PIDD with unknown CMV serostatus, we aimed to evaluate the relationship between pre‐HSCT recipient and donor serostatus and incidence of CMV infection in recipients with unknown serostatus. Methods A retrospective analysis of all pediatric PIDD HSCTs (2007‐2018) was performed at University of California San Francisco. Recipients were separated into categories based on pre‐transplant serostatus: 1) seropositive (R(+)), 2) seronegative (R(‐)), and 3) unknown serostatus (R(x)). Patients with pre‐HSCT active CMV viremia were excluded. Results A total of 90 patients were included, 69% male. The overall incidence of CMV infection was 20%, but varied in R(+), R(‐), and R(x) at 80%, 0%, and 14%, ( P ‐value = .0001). Similarly, 5‐year survival differed among groups, 60% R(+), 100% R(‐), and 90% of R(x) ( P ‐value = .0045). There was no difference in CMV reactivation by donor serostatus ( P ‐value = .29), however, faster time to clearance of CMV was observed for R(x)/D(+) group (median 9.5 days (IQR 2.5‐18), P ‐value = .024). Conclusion We identify a novel group of recipients, R(x), with an intermediate level of survival and CMV incidence post‐HSCT, when compared to seropositive and seronegative recipients. No evidence of CMV transmission from D(+) in R(‐) and R(x) was observed. We believe R(x) should be considered as a separate category in future studies to better delineate recipient risk status.