title: Clinical utility of molecular surveillance for cytomegalovirus after antiviral prophylaxis in high-risk solid organ transplant recipients.
abstract: BACKGROUND
  Cytomegalovirus (CMV) disease after discontinuation of prophylaxis is a significant problem for CMV-seronegative recipients of CMV-seropositive organs (donor seropositive and recipient seronegative [D+/R-]). Virologic monitoring after prophylaxis has been proposed as a way to prevent late-onset disease.
  
  
  METHODS
  We reviewed the efficacy of this strategy. CMV D+/R- organ transplant recipients received 3 to 6 months of antiviral prophylaxis, and then viral loads were performed weekly for 8 weeks. Preemptive antiviral therapy was initiated at a predefined threshold.
  
  
  RESULTS
  Seventy-one CMV D+/R- patients were assessed. Symptomatic CMV disease occurred in 29 of 71 (40.8%) patients during the first-year posttransplant. A significant portion of disease occurred only after the 8-week surveillance period (n=16). Viremia occurred in 19 of 71 (26.8%) patients during the 8-week surveillance. Preemptive therapy was successfully used in only 3 of 19 (15.8%) viremic patients with no further disease development. The remaining patients cleared low-level viremia spontaneously (n=3) or had CMV disease (n=13) either at the first detection of viremia or before preemptive therapy initiation because of rapid viral load doubling (median doubling time 1.1 days).
  
  
  CONCLUSIONS
  CMV D+/R- patients had significant incidence of late-onset disease after prophylaxis. However, the use of a preemptive after prophylaxis strategy was of limited benefit in this group because of rapid viral doubling times and disease occurring after the surveillance period.
authors: Transplant Infectious Diseases, University of Alberta, Edmonton, AB, Canada.
authors: Luiz F
authors: LF
authors: Lisboa
authors: Jutta K
authors: JK
authors: Preiksaitis
authors: Atul
authors: A
authors: Humar
authors: Deepali
authors: D
authors: Kumar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003587:Cytomegalovirus / Q000235:genetics*; D003586:Cytomegalovirus Infections / Q000097:blood / Q000175:diagnosis* / Q000517:prevention & control*; D004279:DNA, Viral / Q000097:blood*; D005260:Female; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D000077562:Valganciclovir; D019562:Viral Load / Q000379:methods*; D014766:Viremia / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D000077562:Valganciclovir; D015774:Ganciclovir