title: Determinants of protracted cytomegalovirus infection in solid-organ transplant patients.
abstract: BACKGROUND
  Recurrent infection frequently follows the response to the initial treatment of cytomegalovirus (CMV) infection in solid-organ transplant (SOT) recipients. The objective of this study was to describe the course of CMV infection in SOT patients and to identify factors that would predict protracted CMV infection with recurrences.
  
  
  METHODS
  Quantitative polymerase chain reaction (PCR) assay for CMV DNA in leukocytes and in plasma were used to assess viral load changes retrospectively in consecutive SOT patients, whose CMV infection episodes had been attended therapeutically or preemptively using quantitative blood culture.
  
  
  RESULTS
  Among 101 SOT patients, CMV infection occurred in 63, of whom 32 developed recurrent infection after the initial episode. In patients with recurrent infection, PCR indicated that a majority (27) of recipients had high level of CMV DNA in peripheral blood leukocytes and plasma throughout a protracted (>/=1 month) period including after preemptive or therapeutic ganciclovir courses. Predictors of protracted high-level infection were increasing age, CMV donor seropositivity, and all measures of viral load during the initial episode. CMV recipient seropositivity protected strongly against protracted infection. End of treatment plasma CMV DNA best discriminated between patients who did or did not develop protracted infection.
  
  
  CONCLUSIONS
  In SOT patients, protracted CMV infection is associated with increasing age, donor seropositivity, recipient seronegativity, and high viral load during the first episode. End of therapy plasma CMV DNA level best predicts the occurrence of protracted infection. In patients with a high risk of protracted infection, prophylaxis is likely to be particularly cost effective.
authors.affiliation: Institut de Microbiologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. ascal.meylan@chuv.hospvd.ch.
authors.forename: Carmen
authors.initials: C
authors.lastname: Muheim
authors.forename: Gérard
authors.initials: G
authors.lastname: Vogel
authors.forename: Charles
authors.initials: C
authors.lastname: Seydoux
authors.forename: Michel
authors.initials: M
authors.lastname: Gillet
authors.forename: François
authors.initials: F
authors.lastname: Mosimann
authors.forename: Ludwig
authors.initials: L
authors.lastname: Von Segesser
authors.forename: Roland
authors.initials: R
authors.lastname: Sahli
authors.forename: Christine
authors.initials: C
authors.lastname: Estrade
authors.forename: Guy
authors.initials: G
authors.lastname: van Melle
authors.forename: Pascal R A
authors.initials: PR
authors.lastname: Meylan
mesh_terms: D000328:Adult; D000368:Aged; D003586:Cytomegalovirus Infections / Q000453:epidemiology / Q000209:etiology* / Q000821:virology; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D016133:Polymerase Chain Reaction; D012307:Risk Factors; D019562:Viral Load