Clinical predictors of progression and clearance of low‐level CMV DNAemia in solid organ transplant recipients. Issue 1 (19th November 2019)

• Record Type: Journal Article
• Authors: Natori, Yoichiro; Alghamdi, Ali; Husain, Shahid; Rotstein, Coleman; Selzner, Nazia; Tikkanen, Jussi; Schiff, Jeffrey; Humar, Atul; Kumar, Deepali
• Is Part Of: Transplant infectious disease. Volume 22:Issue 1(2020)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2019-11-19
• Subjects: cohort -- DNAemia -- progression -- spontaneous clearance -- viral load -- viremia; Transplantation of organs, tissues, etc -- Complications -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 617.01
• DOI: 10.1111/tid.13207
• Languages: English
• ISSNs: 1398-2273

Abstract

Abstract: 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.