An assessment of donor-to-recipient transmission patterns of human cytomegalovirus by analysis of viral genomic variants.
BACKGROUND
We studied human cytomegalovirus (CMV) donor-to-recipient transmission patterns in organ transplantation by analyzing genomic variants on the basis of CMV glycoprotein B (gB) genotyping.


METHODS
Organ transplant recipients were included in the study if they had CMV viremia, if they had received an organ from a CMV-seropositive donor, and if there was at least 1 other recipient of an organ from the same donor who developed CMV viremia. Genotypes (gB1-4) were determined by real-time polymerase chain reaction.


RESULTS
Forty-seven recipients of organs from 21 donors developed CMV viremia. Twenty-three recipients had a pretransplant donor/recipient (D/R) CMV serostatus of D(+)/R(+), and 24 had a serostatus of D(+)/R(-). The prevalences of genotypes in recipients were as follows: for gB1, 51% (n = 24); for gB2, 19% (n = 9); for gB3, 9% (n = 4); for gB4, 0% (n = 0); and for mixed infection, 21% (n = 10). Recipients of an organ from a common donor had infection with CMV of the same gB genotype in 12 (57%) of 21 instances. Concordance between genotypes was higher among seronegative (i.e., D(+)/R(-)) recipients than among seropositive (D(+)/R(+)) recipients, although discordances resulting from the transmission of multiple strains were seen. In seropositive recipients, transmission of multiple strains from the donor could not be differentiated from reactivation of a recipient's own strains.


CONCLUSIONS
Our analysis of strain concordance among recipients of organs from common donors showed that transmission of CMV has complex dynamic patterns. In seropositive recipients, transmission or reactivation of multiple CMV strains is possible.
Manuel
Oriol
O
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. oriol.manuel@chuv.ch
Pang
Xiaoli L
XL
Humar
Atul
A
Kumar
Deepali
D
Doucette
Karen
K
Preiksaitis
Jutta K
JK
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D003587:Cytomegalovirus / Q000235:genetics*; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000235:genetics* / Q000276:immunology / Q000635:transmission*; D017931:DNA Primers; D005260:Female; D014644:Genetic Variation; D005838:Genotype; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects; D016133:Polymerase Chain Reaction; D011110:Polymorphism, Genetic
D000998:Antiviral Agents; D017931:DNA Primers; D007166:Immunosuppressive Agents