Nina Singh1, Drew J Winston2, Raymund R Razonable3, G Marshall Lyon4, Fernanda P Silveira5, Marilyn M Wagener1, Ajit P Limaye6. 1. Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. 2. Department of Medicine, University of California, Los Angeles Medical Center, Los Angeles, California, USA. 3. Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA. 4. Department of Medicine, Emory University, Atlanta, Georgia, USA. 5. Department of Medicine, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. 6. Department of Medicine, University of Washington, Seattle, Washington, USA.
Abstract
BACKGROUND: Detailed cytomegalovirus (CMV) kinetics in donor CMV-seropositive, recipient CMV-seronegative (D+/R-) transplant recipients receiving preemptive therapy (PET) have not been fully defined. METHODS: The study population consisted of the PET arm of a randomized CMV prevention trial in D+/R- liver transplant recipients. CMV DNA polymerase chain reaction (PCR) assays were performed weekly for 100 days using a sensitive assay. Viral load and clinical parameters were compared for patients with or without high-level increase (defined as higher than the group median log10 increase in viral load from baseline after PET initiation). RESULTS: Among 79 patients, 93.6% (74/79) developed an increase from baseline viral loads of median 120 IU/mL to 3350 IU/mL; 25.7% (19/74) of the patients had peak levels >10 000 IU/mL. None of the patients with rise in viral load underwent testing for CMV resistance, and viremia resolved with PET with valganciclovir. Patients with high-level increase in viral load had a significantly lower rate of recurrent viremia than those without such increase (16/40 [40%] vs 28/39 [71.8%], respectively; P = .004). CONCLUSIONS: A majority of D+/R- recipients had a marked increase in viral load after initiation of PET before resolution of viremia. This phenomenon is associated with lower rates of subsequent recurrent viremia and does not necessarily imply antiviral resistance.
BACKGROUND: Detailed cytomegalovirus (CMV) kinetics in donor CMV-seropositive, recipient CMV-seronegative (D+/R-) transplant recipients receiving preemptive therapy (PET) have not been fully defined. METHODS: The study population consisted of the PET arm of a randomized CMV prevention trial in D+/R- liver transplant recipients. CMV DNA polymerase chain reaction (PCR) assays were performed weekly for 100 days using a sensitive assay. Viral load and clinical parameters were compared for patients with or without high-level increase (defined as higher than the group median log10 increase in viral load from baseline after PET initiation). RESULTS: Among 79 patients, 93.6% (74/79) developed an increase from baseline viral loads of median 120 IU/mL to 3350 IU/mL; 25.7% (19/74) of the patients had peak levels >10 000 IU/mL. None of the patients with rise in viral load underwent testing for CMV resistance, and viremia resolved with PET with valganciclovir. Patients with high-level increase in viral load had a significantly lower rate of recurrent viremia than those without such increase (16/40 [40%] vs 28/39 [71.8%], respectively; P = .004). CONCLUSIONS: A majority of D+/R- recipients had a marked increase in viral load after initiation of PET before resolution of viremia. This phenomenon is associated with lower rates of subsequent recurrent viremia and does not necessarily imply antiviral resistance.
Authors: A Asberg; A Humar; H Rollag; A G Jardine; H Mouas; M D Pescovitz; D Sgarabotto; M Tuncer; I L Noronha; A Hartmann Journal: Am J Transplant Date: 2007-07-19 Impact factor: 8.086
Authors: P Grossi; S Kusne; C Rinaldo; K St George; M Magnone; J Rakela; J Fung; T E Starzl Journal: Transplantation Date: 1996-06-15 Impact factor: 4.939
Authors: Ajit P Limaye; Margaret L Green; Bradley C Edmison; Terry Stevens-Ayers; Sam Chatterton-Kirchmeier; Adam P Geballe; Nina Singh; Michael Boeckh Journal: J Infect Dis Date: 2019-07-31 Impact factor: 5.226
Authors: Nina Singh; Drew J Winston; Raymund R Razonable; G Marshall Lyon; Fernanda P Silveira; Marilyn M Wagener; Terry Stevens-Ayers; Bradley Edmison; Michael Boeckh; Ajit P Limaye Journal: JAMA Date: 2020-04-14 Impact factor: 56.272
Authors: S F Atabani; C Smith; C Atkinson; R W Aldridge; M Rodriguez-Perálvarez; N Rolando; M Harber; G Jones; A O'Riordan; A K Burroughs; D Thorburn; J O'Beirne; R S B Milne; V C Emery; P D Griffiths Journal: Am J Transplant Date: 2012-05-17 Impact factor: 8.086
Authors: Carolin Vegvari; Christoforos Hadjichrysanthou; Emilie Cauët; Emma Lawrence; Anne Cori; Frank de Wolf; Roy M Anderson Journal: PLoS One Date: 2016-07-01 Impact factor: 3.240