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Impact and outcomes of primary cytomegalovirus disease in seronegative abdominal solid organ transplant recipients of cytomegalovirus unexposed donors (D‐/R‐)
Author(s) -
Jorgenson Margaret R.,
Descourouez Jillian L.,
Yang DouYan,
Stalter Lily N.,
Leverson Glen E.,
Parajuli Sandesh,
Mandelbrot Didier A.,
Smith Jeannina A.,
Redfield Robert R.
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.13564
Subject(s) - medicine , serostatus , cytomegalovirus , disease , concomitant , gastroenterology , organ transplantation , immunology , transplantation , viral load , viral disease , herpesviridae , virus
Background Primary cytomegalovirus (CMV) disease in high‐risk (D+/R‐) abdominal solid organ transplant recipients (aSOTRs) is well described, however, little is known of primary CMV disease in low‐risk (D‐/R‐) patients. Methods Observational study of adult aSOTRs between 1/1/2009 and 9/1/2019 screened based on serostatus at transplant; D‐/R‐ and D+/R‐ patients were included. Primary objective: Describe epidemiology of primary CMV in D‐/R‐ aSOTRs. Secondary objective: Compare infectious and transplant‐related outcomes of primary CMV disease in the first 90 days (early CMV) between D‐/R‐ and D+/R‐. Results Of 782 D‐/R‐ aSOTRs in the study period, 13 developed CMV at any time after transplant to last follow‐up. Of 671 D+/R‐ patients, 186 developed CMV. Early CMV disease was significantly more common in the D‐/R‐ group (54% vs 15.6%, P = .0005) despite populations being similar demographically, including allograft subtype. D‐/R‐ patients with early CMV disease had median viral load >100 000 IU/mL and 42.9% had end‐organ manifestations; 71.4% required hospital admission. Immunosuppressive therapy was adjusted in 100% of patients, there was an approximately 14.3% rate of antiviral resistance and 28.6% had concomitant opportunistic infection. These findings were similar to D+/R‐ patients. There was no difference in risk of rejection or all‐cause mortality associated with early CMV disease, however, graft loss was significantly higher in D‐/R‐. Conclusion D‐/R‐ aSOTRs infrequently develop CMV, however, when it occurs, they present with disease manifestations similar to and graft outcomes inferior to D+/R‐ with CMV. Additionally, the majority of CMV disease in D‐/R‐ occurs in the first 90 days after transplant, suggesting possible donor subclinical infection or transfusion source. The complicated course in D‐/R‐ is likely caused by low clinical suspicion. Awareness of disease severity and aggressive upfront management may promote positive outcomes.