title: Clinical predictors of relapse after treatment of primary gastrointestinal cytomegalovirus disease in solid organ transplant recipients.
abstract: Primary gastrointestinal cytomegalovirus (CMV) disease after solid organ transplantation (SOT) is difficult to treat and may relapse. Herein, we reviewed the clinical records of CMV D+/R- SOT recipients with biopsy-proven gastrointestinal CMV disease to determine predictors of relapse. The population consisted of 26 kidney (13 [50%]), liver (10 [38%]) and heart (3 [12%]) transplant recipients who developed gastrointestinal CMV disease at a median of 54 (interquartile range [IQR]: 40-70) days after stopping antiviral prophylaxis. Except for one patient, all received induction intravenous ganciclovir (mean+/-SD, 33.8+/-19.3 days) followed by valganciclovir (27.5+/-13.3 days) in 18 patients. Ten patients further received valganciclovir maintenance therapy (41.6+/-28.6 days). The median times to CMV PCR negativity in blood was 22.5 days (IQR: 16.5-30.7) and to normal endoscopic findings was 27.0 days (IQR: 21.0-33.5). CMV relapse, which occurred in seven (27%) patients, was significantly associated with extensive disease (p=0.03). CMV seroconversion, viral load, treatment duration, maintenance therapy and endoscopic findings at the end of therapy were not significantly associated with CMV relapse. In conclusion, an extensive involvement of the gastrointestinal tract was significantly associated with CMV relapse. However, endoscopic evidence of resolution of gastrointestinal disease did not necessarily translate into a lower risk of CMV relapse.
authors.affiliation: Division of Infectious Diseases, The William J von Liebig Transplant Center, College of Medicine, Mayo Clinic, Rochester, Minnesota, MN, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Eid
authors.forename: S K
authors.initials: SK
authors.lastname: Arthurs
authors.forename: P J
authors.initials: PJ
authors.lastname: Deziel
authors.forename: M P
authors.initials: MP
authors.lastname: Wilhelm
authors.forename: R R
authors.initials: RR
authors.lastname: Razonable
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003587:Cytomegalovirus / Q000235:genetics / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000209:etiology* / Q000635:transmission / Q000821:virology; D005260:Female; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D005767:Gastrointestinal Diseases / Q000188:drug therapy* / Q000209:etiology* / Q000821:virology; D016027:Heart Transplantation / Q000009:adverse effects; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D019737:Transplants / Q000009:adverse effects* / Q000821:virology*; D000077562:Valganciclovir; D019562:Viral Load / Q000187:drug effects; D014766:Viremia / Q000188:drug therapy / Q000209:etiology / Q000821:virology
chemical_list: D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir