Unknown cytomegalovirus serostatus in primary immunodeficiency disorders: A new category of transplant recipients. Issue 2 (29th November 2020)

• Record Type: Journal Article
• Authors: Forlanini, Federica; Dara, Jasmeen; Dvorak, Christopher C.; Cowan, Morton J.; Puck, Jennifer M.; Dorsey, Morna J.
• Is Part Of: Transplant infectious disease. Volume 23:Issue 2(2021)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2020-11-29
• Subjects: Cytomegalovirus -- hematopoietic stem cell transplant -- infection -- primary immunodeficiency -- serostatus; Transplantation of organs, tissues, etc -- Complications -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 617.01
• DOI: 10.1111/tid.13504
• Languages: English
• ISSNs: 1398-2273

Abstract

Abstract: 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.