Nina Singh1, Drew J Winston2, Raymund R Razonable3, G Marshall Lyon4, Fernanda P Silveira5, Marilyn M Wagener1, Ajit P Limaye6. 1. University of Pittsburgh and VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA. 2. University of California Los Angeles Medical Center, Los Angeles, California, USA. 3. Mayo Clinic, Rochester, Minnesota, USA. 4. Emory University, Atlanta, Georgia, USA. 5. University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. 6. University of Washington, Seattle, Washington, USA.
Abstract
BACKGROUND: The risk factors for development of viremia in high-risk donor cytomegalovirus (CMV)-seropositive and recipient CMV-seronegative (D+R-) transplant recipients are incompletely defined. METHODS: The study population comprised patients in the preemptive therapy (PET) arm of a randomized, controlled trial of PET versus prophylaxis using valganciclovir in D+R- liver transplant recipients. Weekly surveillance monitoring for viremia for 100 days was performed using a sensitive CMV-DNA polymerase chain reaction assays. Risk factors for viremia and time to onset (≤4 vs >4 weeks) of viremia were examined using logistic regression models. RESULTS: Viremia developed in 84% (79/94) of recipients and older donor age was the only independent factor associated with viremia (odds ratio, 2.20 for each quartile increase in donor age; 95% confidence interval [CI], 1.07-4.52; P = .031). Recipients who developed early-onset viremia (within 4 weeks) also had significantly older donors than those with later-onset viremia (difference in age 10.1 years; 95% CI, 2-19; P = .03). CONCLUSIONS: Older donor age was an independent predictor of viremia and earlier-onset of viremia in D+R- liver transplant recipients. Future studies should assess the mechanistic links underlying this novel association. CLINICAL TRIAL REGISTRATION: NCT01552369.
BACKGROUND: The risk factors for development of viremia in high-risk donor cytomegalovirus (CMV)-seropositive and recipient CMV-seronegative (D+R-) transplant recipients are incompletely defined. METHODS: The study population comprised patients in the preemptive therapy (PET) arm of a randomized, controlled trial of PET versus prophylaxis using valganciclovir in D+R- liver transplant recipients. Weekly surveillance monitoring for viremia for 100 days was performed using a sensitive CMV-DNA polymerase chain reaction assays. Risk factors for viremia and time to onset (≤4 vs >4 weeks) of viremia were examined using logistic regression models. RESULTS: Viremia developed in 84% (79/94) of recipients and older donor age was the only independent factor associated with viremia (odds ratio, 2.20 for each quartile increase in donor age; 95% confidence interval [CI], 1.07-4.52; P = .031). Recipients who developed early-onset viremia (within 4 weeks) also had significantly older donors than those with later-onset viremia (difference in age 10.1 years; 95% CI, 2-19; P = .03). CONCLUSIONS: Older donor age was an independent predictor of viremia and earlier-onset of viremia in D+R- liver transplant recipients. Future studies should assess the mechanistic links underlying this novel association. CLINICAL TRIAL REGISTRATION: NCT01552369.
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