Prevention of cytomegalovirus disease using pre-emptive treatment after solid organ transplant in patients at high risk for cytomegalovirus infection.
BACKGROUND
The use of pre-emptive or prophylactic treatment to control cytomegalovirus (CMV) replication after solid organ transplant (SOT) remains controversial. The aim of this study was to evaluate whether administration of pre-emptive treatment to control viral replication guided by a highly sensitive diagnostic tool is an effective approach for preventing CMV disease, even in high-risk transplant recipients.


METHODS
Plasma samples from eight SOT patients were tested using antigenaemia and real-time PCR (RT-PCR) assays. Pre-emptive treatment was administered guided by RT-PCR when viral load values were >1,000 copies/ml.


RESULTS
All patients developed episodes of CMV infection, but none of them developed CMV disease or indirect effects. No patient in this study died or experienced graft rejection. Treatment was needed in 10 replication episodes. At the end of treatment, four had undetectable levels and the other six were cleared 3 weeks later. In 42.6% of tested samples RT-PCR was more sensitive for detecting viral infection.


CONCLUSIONS
Pre-emptive monitoring of SOT patients at high risk for CMV infection protected patients from developing CMV disease during the first 6 months after transplant. The use of this sensitive method for guiding pre-emptive treatment diminished viral load early enough that it did not have consequences for patient health.
Benmarzouk-Hidalgo
Omar Jesus
OJ
Service of Infectious Diseases, Hospitales Universitarios Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain.
Cordero
Elisa
E
Martín-Peña
Almudena
A
García-Prado
Elena
E
Gentil
Miguel Angel
MA
Gomez-Bravo
Miguel Angel
MA
Barrera-Pulido
Lydia
L
Cisneros
Jose Miguel
JM
Perez-Romero
Pilar
P
D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use; D003587:Cytomegalovirus / Q000187:drug effects* / Q000235:genetics / Q000502:physiology; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control* / Q000821:virology; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D010750:Phosphoproteins / Q000097:blood; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012306:Risk; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D000077562:Valganciclovir; D019562:Viral Load; D014763:Viral Matrix Proteins / Q000097:blood
D000998:Antiviral Agents; D010750:Phosphoproteins; D014763:Viral Matrix Proteins; C065418:cytomegalovirus matrix protein 65kDa; D000077562:Valganciclovir; D015774:Ganciclovir