title: Prevention of cytomegalovirus disease using pre-emptive treatment after solid organ transplant in patients at high risk for cytomegalovirus infection.
abstract: 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.
authors.affiliation: Service of Infectious Diseases, Hospitales Universitarios Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain.
authors.forename: Omar Jesus
authors.initials: OJ
authors.lastname: Benmarzouk-Hidalgo
authors.forename: Elisa
authors.initials: E
authors.lastname: Cordero
authors.forename: Almudena
authors.initials: A
authors.lastname: Martín-Peña
authors.forename: Elena
authors.initials: E
authors.lastname: García-Prado
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Gentil
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Gomez-Bravo
authors.forename: Lydia
authors.initials: L
authors.lastname: Barrera-Pulido
authors.forename: Jose Miguel
authors.initials: JM
authors.lastname: Cisneros
authors.forename: Pilar
authors.initials: P
authors.lastname: Perez-Romero
mesh_terms: 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
chemical_list: D000998:Antiviral Agents; D010750:Phosphoproteins; D014763:Viral Matrix Proteins; C065418:cytomegalovirus matrix protein 65kDa; D000077562:Valganciclovir; D015774:Ganciclovir