Definitions of Cytomegalovirus Infection and Disease in Transplant Recipients

Ljungman, Per; Griffiths, Paul; Payá, Carlos V.

doi:10.1086/339329

Cited by 1,152 publications

(951 citation statements)

References 14 publications

Supporting

Mentioning

894

Contrasting

Unclassified

Order By: Relevance

“…In the present study, no attempts were made to distinguish CMV antigenemia from CMV disease or infection (the latter is a clinicovirologic correlate) (14). Nonetheless, CMV antigenemia is abnormal, and the circulatory viral burden generally correlates with the degree of severity of CMV disease.…”

Section: Discussionmentioning

confidence: 68%

Epidemiologic Analysis of Reactivated Cytomegalovirus Antigenemia in Patients with Cancer

Han

2007

J Clin Microbiol

View full text Add to dashboard Cite

The epidemiologic features of reactivated cytomegalovirus (CMV) antigenemia were studied among 4,382 cancer patients who were cared for and tested at the University of Texas M. D. Anderson Cancer Center from 2001 to 2004. The effects of stem cell transplant (SCT) status, underlying disease, age, sex, ethnicity, and antibody status (prior to CMV exposure) on the incidence of CMV antigenemia were determined; and the CMV burdens were quantified. Antigenemia occurred in 9.3% of patients with non-SCT (n ‫؍‬ 2511), 12.0% with autologous SCT (n ‫؍‬ 582), and 39.1% with allogeneic SCT (n ‫؍‬ 1289). Non-SCT patients with lymphoid tumors had a significantly higher rate of antigenemia than those with myeloid tumors (13.6% versus 3.9%) (P < 0.001); however, after allogeneic SCT, the underlying diseases had little effect, except for multiple myeloma (56.8%) (P ‫؍‬ 0.014). Among the allogeneic SCT recipients, higher CMV antigenemia rates were also associated with female sex, older age, and positivity for pre-SCT CMV antibody. Depending on the underlying disease and its associated initial CMV risk, allogeneic SCT increased the risk by 2.6-to 29.6-fold (overall, 4.0-fold). With or without SCT, Asians had the highest CMV antigenemia rates and burdens, followed by blacks, Hispanics, and whites, and these partially correlated with antibody prevalence. Among the 808 patients with antigenemia, the circulating peak CMV burden was significantly higher among non-SCT patients (geometric mean, 18.7 positive cells per 10 6 leukocytes) than among allogeneic SCT patients (geometric mean, 7.7 positive cells per 10 6 leukocytes) or autologous SCT patients (geometric mean, 7.0 positive cells per 10 6 leukocytes) who underwent monitoring for CMV. Together, these results allow stratification of CMV risks and suggest a substantial CMV reactivation among non-SCT cancer patients and, thus, the need for better diagnosis and control.Human cytomegalovirus (CMV), a ␤-herpesvirus, causes a variety of infections, such as congenital infections in neonates, infectious mononucleosis in healthy individuals, and reactivation in immunocompromised patients (18). CMV reactivation is a common and severe problem in organ and stem cell transplant (SCT) recipients and in those infected with human immunodeficiency virus (HIV), particularly before the era of effective antiretroviral therapy. Among SCT recipients, the rate of CMV reactivation in the bloodstream (antigenemia or viremia) has been reported to be from 30% to 70% (2, 11, 13). Routine monitoring of CMV antigenemia by testing for the CMV pp65 antigen (or other means) has played a crucial role in detecting the virus and guiding effective antiviral therapy in SCT recipients (4, 16).The incidence of CMV antigenemia among patients who have severe underlying diseases, such as leukemia, lymphoma, or solid tumors, but who are not transplant recipients or HIV infected is largely unknown. In this population, CMV antigenemia has been reported only in small series or case studies (7-9). Even among SCT and organ transpla...

show abstract

Section: Discussionmentioning

confidence: 68%

Epidemiologic Analysis of Reactivated Cytomegalovirus Antigenemia in Patients with Cancer

Han

2007

J Clin Microbiol

View full text Add to dashboard Cite

show abstract

“…Delayed graft function (DGF) was defined as the necessity for dialysis during the first week after transplantation (Sagedal et al 2002). CMV disease was defined as the presence of fever with one or more of the following: leukopenia, gastrointestinal disease, pancreatitis, hepatitis, pneumonitis, or nephritis as well as virological proof obtained using the quantitative polymerase chain reaction or histological evidence of the endothelial cell inclusion of viral particles (Ljungman et al 2002).…”

Section: Definitionsmentioning

confidence: 99%

Early-Onset Graft Pyelonephritis Is Predictive of Long-Term Outcome of Renal Allografts

Shin

Kim

Lee

et al. 2015

Tohoku J. Exp. Med.

View full text Add to dashboard Cite

Urinary tract infection (UTI) is the most common bacterial infection encountered in kidney transplant recipients. Graft pyelonephritis (GPN) is associated with acute kidney injury and renal allograft scarring. However, the influence of GPN on renal allograft outcome in kidney transplant recipients remains controversial. Two hundred sixty-five kidney transplant recipients were evaluated for the impact of earlyonset GPN on renal allograft functions between January 2001 and December 2011. Early-onset GPN was defined as the first GPN episode occurring within 6 months after kidney transplantation. Thirty recipients (11.3%) were diagnosed with early-onset GPN. During the mean follow-up period of 69.1 ± 28.9 months, 56 (21.1%) recipients showed renal allograft outcomes of a > 30% reduction in the estimated glomerular filtration rate (eGFR) over 2 years. The poor outcome was significantly more frequent in the early-onset GPN group (13 patients; 43.3%) than in those without early-onset GPN (43 patients; 18.3%) (P = 0.002). Moreover, the linear mixed model revealed a significant difference in the eGFR decline rate over time between the two groups (P < 0.001). Kaplan-Meier analysis showed that renal allograft event-free survival was significantly lower in the early-onset GPN group (P = 0.006). Multivariate Cox regression analyses revealed that early-onset GPN was independently predictive of poor renal allograft outcomes (hazard ratio, 1.96; 95% confidence interval, 1.02-3.77; P = 0.04). In conclusion, early-onset GPN is independently associated with impaired renal functions in kidney transplant recipients. Thus, early-onset GPN could be a predictor for long-term outcome of renal allografts.

show abstract

“…More detailed definitions of CMV-D have been published elsewhere. 23 Pre-emptive therapy Intravenous ganciclovir or foscarnet was started only if CMV antigenemia and/or viremia were detected or when CMV DNA was detected by quantPCR as describe above, at a dose of 5 and 60 mg/kg i.v., respectively, every 12 h for 14 days followed by 5 and 60 mg/kg daily Monday to Friday for 14 days, respectively. Patients with recurrent infection received a second course.…”

Section: Screening Periodmentioning

confidence: 99%

Cytomegalovirus infection and disease after reduced intensity conditioning allogeneic stem cell transplantation: single-centre experience

Piñana

Martino

Barba

et al. 2009

Bone Marrow Transplant

View full text Add to dashboard Cite

The aim of this study was to analyse the incidence and risk factors for cytomegalovirus infection (CMV-I) and disease (CMV-D) after a reduced intensity conditioning allogeneic hematopoietic stem cell transplantation (alloHSCT-RIC). We included 186 consecutive alloHSCT-RIC adult patients at risk for CMV reactivation (patient and/or donor CMV seropositivity). Conditioning regimen was based on fludarabine plus an alkylating agent. For guiding pre-emptive anti-CMV therapy, Pp65 Antigenemia (pp65Ag) (n ¼ 116) or quantitative polymerase chain reaction (quantPCR) (n ¼ 70) were used. The 2-year incidence of CMV-I and/or CMV-D was 36% (11% for CMV-D). Of note, 12/14 (86%) episodes of CMV-D in the pp65Ag group had lung involvement compared with only 3/ 15 (20%) in the quantPCR group (P ¼ 0.01). Importantly, the number of patients who developed CMV pneumonia with prior negative screening tests was unusually high (67% overall). Multivariate analysis of risk factors for CMV-D identified two risk factors: (i) steroid therapy for moderateto-severe graft-vs-host disease (GVHD) (hazard ratio 4.7, P ¼ 0.02); and (ii) alternative donors (non-HLA-identical siblings) [hazard ratio 2.7, P ¼ 0.002]. Our findings suggest that CMV is still a major concern in alloHSCT-RIC. Variables associated with poor anti-CMV T-cell recovery (that is, GVHD and donor type) are helpful in identifying patients at higher risk for CMV-D in the alloHSCT-RIC setting.

show abstract

Definitions of Cytomegalovirus Infection and Disease in Transplant Recipients

Cited by 1,152 publications

References 14 publications

Epidemiologic Analysis of Reactivated Cytomegalovirus Antigenemia in Patients with Cancer

Epidemiologic Analysis of Reactivated Cytomegalovirus Antigenemia in Patients with Cancer

Early-Onset Graft Pyelonephritis Is Predictive of Long-Term Outcome of Renal Allografts

Cytomegalovirus infection and disease after reduced intensity conditioning allogeneic stem cell transplantation: single-centre experience

Contact Info

Product

Resources

About