The Incidence and Effect of Cytomegalovirus Disease on Mortality in Transplant Recipients and General Population: Real-world Nationwide Cohort Data

Han, Sang Hoon; Yoo, Seul Gi; Han, Kyung Do; La, Yeonju; Kwon, Da Eun; Lee, Kyoung Hwa

doi:10.7150/ijms.62621

Cited by 12 publications

(13 citation statements)

References 63 publications

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“…The adjusted incidence rate of CMV disease in Korea, excluding CMV syndrome, was recently reported to be 33.1 (95% confidence interval [CI], 28.8–38.0) per 1,000 person-years in SOT and 5.1 (95% CI, 4.6–6.1) per 1,000 person-years in hematopoietic stem cell transplant (HSCT) recipients. In the SOT cohort, heart transplant recipients had the highest rate of CMV disease, at 104.2 (95% CI, 66.4–163.7) per 1,000 person-years, liver transplant recipients showed the lowest rate, at 11.1 (95% CI, 7.7–16.3) per 1,000 person-years, and renal transplant recipients had an intermediate rate, at 44.3 (95% CI, 37.7–52.1) per 1,000 person-years [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

Laboratory diagnostic testing for cytomegalovirus infection in solid organ transplant patients

Lee

2022

Korean J Transplant

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Human cytomegalovirus (CMV) infection, which is one of the most common complications in transplant recipients, increases the risk of graft loss and rejection. Laboratory strategies for diagnosing CMV infection rely on the measurement of viral DNAemia and CMV-specific cell-mediated immunity (CMV-CMI). The CMV quantitative nucleic acid amplification test (QNAT) enabled the spread of preemptive therapy and prompted recommendations for surveillance, diagnosis, and monitoring. Despite the implementation of the World Health Organization international standard for calibration, variability of QNAT persists due to technical issues. CMV immunoglobulin G serology is the standard method for CMV immune screening of transplant candidates and donors. Assays for CMV-CMI play an important role in helping to predict the risk and to develop an individualized CMV management plan. Genotypic testing for resistance is needed when drug-resistant CMV infection is suspected. Here, we review the state of the art of laboratory tests for CMV infection in solid organ transplantation.

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Section: Introductionmentioning

confidence: 99%

Laboratory diagnostic testing for cytomegalovirus infection in solid organ transplant patients

Lee

2022

Korean J Transplant

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“…The number of SOT recipients included across retained studies ranged between 18 in a single center study 18 . and 16 368 in a study conducted using health care databases 19 . The most frequent organ transplanted was the kidney ( n = 34, 69.4%) and/or the liver ( n = 10, 20.4%).…”

Section: Resultsmentioning

confidence: 99%

Epidemiology, management, and burden of cytomegalovirus in solid organ transplant recipients in selected countries outside of Europe and North America: A systematic review

Silva

Tokat

Cai

et al. 2023

Transplant Infectious Dis

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BackgroundCytomegalovirus (CMV) is a frequent infectious complication following solid organ transplantation (SOT). Considering significant differences in healthcare systems, a systematic review was conducted to describe the epidemiology, management, and burden of CMV post‐SOT in selected countries outside of Europe and North America.MethodsMEDLINE, Embase, and Cochrane databases were searched for observational studies in SOT recipients across 15 countries in the regions of Asia, Pacific, and Latin America (search period: January 1, 2011 to September 17, 2021). Outcomes included incidence of CMV infection/disease, recurrence, risk factors, CMV‐related mortality, treatment patterns and guidelines, refractory and/or resistant CMV, patient‐reported outcomes, and economic burden.ResultsOf 2708 studies identified, 49 were eligible (n = 43/49; 87.8% in adults; n = 34/49, 69.4% in kidney recipients). Across studies, selection of CMV preventive strategy was based on CMV serostatus. Overall, rates of CMV infection (within 1 year) and CMV disease post‐SOT were respectively, 10.3%–63.2% (9 studies) and 0%–19.0% (17 studies). Recurrence occurred in 35.4%–41.0% cases (3 studies) and up to 5.3% recipients died of CMV‐associated causes (11 studies). Conventional treatments for CMV infection/disease included ganciclovir (GCV) or valganciclovir. Up to 4.4% patients were resistant to treatment (3 studies); no studies reported on refractory CMV. Treatment‐related adverse events with GCV included neutropenia (2%–29%), anemia (13%–48%), leukopenia (11%–37%), and thrombocytopenia (13%–24%). Data on economic burden were scarce. imageConclusionOutside of North America and Europe, rates of CMV infection/disease post‐SOT are highly variable and CMV recurrence is frequent. CMV resistance and treatment‐associated adverse events, including myelosuppression, highlight unmet needs with conventional therapy.

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“…MELD at inclusion in waiting list, median (IQR) 19 (14-25) 19 (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31) 19 (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) .257…”

Section: Discussionunclassified

“…MELD at LT, median (IQR) 24 (16-30) 29 (18-37) 25 (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) .004…”

Section: Discussionmentioning

confidence: 99%

“…Some variables included in the INCREMENT‐SOT‐CPE score, such as lymphopenia and CMV infection after transplantation, are related to the net state of immunosuppression of the recipient 24,25 . Generally, these complications occurred more frequently in non‐LT recipients due to the more intensive immunosuppression regimens used in those patients 26 . This issue may partially explain the difference in accuracy of INCREMENT‐SOT‐CPE to predict mortality in patients with CRE infection between our cohort of LT recipients and that of the derivation study.…”

Section: Discussionmentioning

confidence: 99%

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Validation of the INCREMENT‐SOT‐CPE score in a large cohort of liver transplant recipients with carbapenem‐resistant Enterobacterales infection

Rinaldi

Bonazzetti

Gallo

et al. 2023

Transplant Infectious Dis

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Background Management of infections due to carbapenemase‐resistant Enterobacterales (CRE) in solid organ transplant (SOT) recipients remains a difficult challenge. The INCREMENT‐SOT‐CPE score has been specifically developed from SOT recipients to stratify mortality risk, but an external validation is lacking. Methods Multicenter retrospective cohort study of liver transplant (LT) recipients colonized with CRE infection who developed infection after transplant over 7‐year period. Primary endpoint was all‐cause 30‐day mortality from infection onset. A comparison between INCREMENT‐SOT‐CPE and other selected scores was performed. A two‐level mixed effects logistic regression model with random effects for the center was fitted. Performance characteristics at optimal cut‐point were calculated. Multivariable Cox regression analysis of risk factors for all‐cause 30‐day mortality was carried out. Results Overall, 250 CRE carriers developed infection after LT and were analyzed. The median age was 55 years (interquartile range [IQR]: 46–62) and 157 were males (62.8%). All‐cause 30‐day mortality was 35.6%. A sequential organ failure assessment (SOFA) score ≥ 11 showed a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 69.7%, 76.4%, 62.0%, 82.0%, and 74.0%, respectively. An INCREMENT‐SOT‐CPE ≥ 11 reported a sensitivity, specificity, PPV, NPV, and accuracy of 73.0%, 62.1%, 51.6%, 80.6% and 66.0%, respectively. At multivariable analysis acute renal failure, prolonged mechanical ventilation, INCREMENT‐SOT‐CPE score ≥ 11 and SOFA score ≥ 11 were independently associated with all‐cause 30‐day mortality, while a tigecycline‐based targeted regimen was found to be protective. Conclusions Both INCREMENT‐SOT‐CPE ≥ 11 and SOFA ≥ 11 were identified as strong predictors of all‐cause 30‐day mortality in a large cohort of CRE carriers developing infection after LT.

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The Incidence and Effect of Cytomegalovirus Disease on Mortality in Transplant Recipients and General Population: Real-world Nationwide Cohort Data

Cited by 12 publications

References 63 publications

Laboratory diagnostic testing for cytomegalovirus infection in solid organ transplant patients

Laboratory diagnostic testing for cytomegalovirus infection in solid organ transplant patients

Epidemiology, management, and burden of cytomegalovirus in solid organ transplant recipients in selected countries outside of Europe and North America: A systematic review

Validation of the INCREMENT‐SOT‐CPE score in a large cohort of liver transplant recipients with carbapenem‐resistant Enterobacterales infection

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