title: Importance of the cytomegalovirus seropositive recipient as a contributor to disease burden after solid organ transplantation.
abstract: BACKGROUND
  The incidence of cytomegalovirus (CMV) syndrome/disease after adult solid organ transplantation in the era effective antiviral therapy has not been fully assessed.
  
  
  OBJECTIVE
  To determines the incidence of CMV syndrome/disease after solid organ transplantation in the UK.
  
  
  METHODS
  A retrospective analysis of 1807 solid organ transplants from 12 UK solid organ transplant centres representing 32.7% of all transplant activity occurring in the UK between 1/04/2004 and 31/03/2006. Patients were categorised into those experiencing an episode of symptomatic CMV infection after transplant or those who remained free of symptoms. All patients were followed up for 2 years for the occurrence of CMV syndrome/disease.
  
  
  RESULTS
  The majority of the transplant centres used valganciclovir prophylaxis in the high risk D+R- patients (91.6%) whereas management of the lower risk D+R+ and D-R+ patients was more variable with deployment of both prophylactic and pre-emptive strategies in ∼50% of centres. CMV syndrome/disease occurred in 20.5% of the D+R- patients representing 55 cases whereas the incidence was only 8.1% and 9% in the D+R+ and D-R+ group, respectively (p<0.001 compared to the D+R- group), but representing a further 58 cases of CMV syndrome/disease. CMV viraemia in the D+R- group was associated with a high probability (65%) of CMV syndrome/disease in renal transplant recipients whereas this was less apparent in the intermediate risk groups.
  
  
  CONCLUSIONS
  CMV syndrome/disease remains an important healthcare burden after solid organ transplantation with the intermediate risk groups contributing similar numbers of cases as the high risk group.
authors.affiliation: Department of Infection (Royal Free Campus), University College Medical School, Rowland Hill Street, Hampstead, London NW3 2QG, UK. v.emery@ucl.ac.uk
authors.forename: Vincent C
authors.initials: VC
authors.lastname: Emery
authors.forename: Kevin
authors.initials: K
authors.lastname: Asher
authors.forename: Cristina de Juan
authors.initials: Cde J
authors.lastname: Sanjuan
mesh_terms: D000328:Adult; D000914:Antibodies, Viral / Q000097:blood*; D003587:Cytomegalovirus / Q000276:immunology*; D003586:Cytomegalovirus Infections / Q000453:epidemiology*; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D016377:Organ Transplantation / Q000009:adverse effects*; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000914:Antibodies, Viral