Direct assessment of cytomegalovirus transfusion-transmitted risks after universal leukoreduction.
BACKGROUND
Cytomegalovirus (CMV) transfusion-transmitted disease (TTD) remains a clinical concern. Universal leukoreduction has become one of the main strategies for the prevention of CMV-TTD. Through prospective clinical follow-up and testing of transfusion recipients (TRs), the risk for CMV-TTD was studied.


METHODS
Transfused units were all leukoreduced and not prospectively screened for CMV. For TRs with negative baseline CMV testing results (CMV total antibody and DNA), all follow-up TR samples were tested for CMV total antibody and DNA, and retained linked donor serum samples were tested for CMV total antibody. In cases when CMV-TTD was suspected, donor sera were also tested for CMV DNA and selected TR samples were tested for CMV immunoglobulin M antibody. Evaluable transfusion was defined as a transfusion with TR sample(s) collected 14 to 180 days posttransfusion.


RESULTS
Forty-six TRs were negative for CMV at baseline. There were 1316 evaluable cellular blood transfusions to these TRs. Of 1316 evaluable cellular products, 460 (35%) were positive for CMV total antibody tested using linked donor samples. Three cases of probable CMV-TTD were found; however, there was no definitive proof from donor follow-up that they were transfusion associated.


CONCLUSIONS
Among all 46 baseline seronegative recipients and 1316 evaluable transfusions, the calculated overall CMV-TTD risk was up to 6.5% (95% confidence interval [CI], 1.0%-18.0%) in terms of TRs and up to 0.23% (95% CI, 0.06%-0.62%) in terms of non-CMV-screened leukoreduced cellular products. In summary, after universal leukoreduction, CMV-TTD, while uncommon, may still occur.
Wu
Yanyun
Y
Department of Laboratory Medicine, Yale University School of Medicine, 20 York Street, CB 459, New Haven, CT 06510-3202, USA. yan.wu@yale.edu
Zou
Shimian
S
Cable
Ritchard
R
Dorsey
Kerri
K
Tang
Yanlin
Y
Hapip
Cheryl Anne
CA
Melmed
Russell
R
Trouern-Trend
Jonathan
J
Wang
Jian-Hui
JH
Champion
Melanie
M
Fang
Chyang
C
Dodd
Roger
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood; D001782:Blood Donors; D003237:Connecticut; D003586:Cytomegalovirus Infections / Q000276:immunology / Q000517:prevention & control* / Q000635:transmission*; D004247:DNA / Q000097:blood / Q000235:genetics / Q000302:isolation & purification; D017931:DNA Primers; D015342:DNA Probes; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D047589:Leukocyte Reduction Procedures / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012703:Serotyping / Q000379:methods; D065227:Transfusion Reaction
D000914:Antibodies, Viral; D017931:DNA Primers; D015342:DNA Probes; D004247:DNA