Clinical utility of cytomegalovirus (CMV) serology testing in high-risk CMV D+/R- transplant recipients.
Late-onset cytomegalovirus (CMV) disease is a significant problem in D+/R- solid organ transplant (SOT) patients who receive antiviral prophylaxis. We assessed the clinical utility of CMV IgG and IgM serology testing for predicting late-onset CMV disease. We evaluated 352 D+/R- transplant recipients who participated in a trial comparing 100 days of ganciclovir versus valganciclovir prophylaxis. CMV serology was assessed on day 28, 56, 100, and 6 and 12 months post-transplant. IgG seroconversion occurred in 26.9% of patients by day 100, and in 63.4% and 75.3% by 6 and 12 months, respectively. IgM seroconversion occurred in 8.3%, 41.8% and 54.9% by day 100, month 6 and month 12, respectively. Seroconversion by day 100 (end of prophylaxis) was not predictive of subsequent CMV disease (CMV disease 13.3% if seropositive vs. 17.8% if seronegative; p = NS). However, at 6 months post-transplant, IgG serostatus was predictive of subsequent CMV disease between month 6 and 12 (CMV disease 1.3% if seropositive vs. 10.0% if seronegative; p = 0.002). In D+/R- patients, CMV serology testing is for the most part not clinically useful for predicting subsequent disease. However, seroconversion by 6 months may be useful for identifying patients at risk of late-onset CMV disease.
Humar
Atul
A
University of Toronto, Toronto, Ontario, Canada. Atul.Humar@uhn.on.ca
Mazzulli
Tony
T
Moussa
George
G
Razonable
Raymund R
RR
Paya
Carlos V
CV
Pescovitz
Mark D
MD
Covington
Emma
E
Alecock
Emma
E
D000998:Antiviral Agents / Q000627:therapeutic use; D003587:Cytomegalovirus / Q000378:metabolism*; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000209:etiology / Q000821:virology*; D004311:Double-Blind Method; D015774:Ganciclovir / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016027:Heart Transplantation / Q000379:methods; D006801:Humans; D007074:Immunoglobulin G / Q000737:chemistry; D007075:Immunoglobulin M / Q000737:chemistry; D016030:Kidney Transplantation / Q000379:methods; D016031:Liver Transplantation / Q000379:methods; D016377:Organ Transplantation / Q000009:adverse effects / Q000379:methods*; D016035:Pancreas Transplantation / Q000379:methods; D012306:Risk; D012698:Serologic Tests / Q000379:methods*; D013997:Time Factors; D000077562:Valganciclovir; D019562:Viral Load
D000998:Antiviral Agents; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D000077562:Valganciclovir; D015774:Ganciclovir