title: Cytomegalovirus replication kinetics in solid organ transplant recipients managed by preemptive therapy.
abstract: After allotransplantation, cytomegalovirus (CMV) may be transmitted from the donor organ, giving rise to primary infection in a CMV negative recipient or reinfection in one who is CMV positive. In addition, latent CMV may reactivate in a CMV positive recipient. In this study, serial blood samples from 689 kidney or liver transplant recipients were tested for CMV DNA by quantitative PCR. CMV was managed using preemptive antiviral therapy and no patient received antiviral prophylaxis. Dynamic and quantitative measures of viremia and treatment were assessed. Median peak viral load, duration of viremia and duration of treatment were highest during primary infection, followed by reinfection then reactivation. In patients who experienced a second episode of viremia, the viral replication rate was significantly slower than in the first episode. Our data provide a clear demonstration of the immune control of CMV in immunosuppressed patients and emphasize the effectiveness of the preemptive approach for prevention of CMV syndrome and end organ disease. Overall, our findings provide quantitative biomarkers which can be used in pharmacodynamic assessments of the ability of novel CMV vaccines or antiviral drugs to reduce or even interrupt such transmission.
authors.affiliation: Division of Infection and Immunity, Centre for Virology, Royal Free NHS Trust & UCL Medical School, London, UK.
authors.forename: S F
authors.initials: SF
authors.lastname: Atabani
authors.forename: C
authors.initials: C
authors.lastname: Smith
authors.forename: C
authors.initials: C
authors.lastname: Atkinson
authors.forename: R W
authors.initials: RW
authors.lastname: Aldridge
authors.forename: M
authors.initials: M
authors.lastname: Rodriguez-Perálvarez
authors.forename: N
authors.initials: N
authors.lastname: Rolando
authors.forename: M
authors.initials: M
authors.lastname: Harber
authors.forename: G
authors.initials: G
authors.lastname: Jones
authors.forename: A
authors.initials: A
authors.lastname: O'Riordan
authors.forename: A K
authors.initials: AK
authors.lastname: Burroughs
authors.forename: D
authors.initials: D
authors.lastname: Thorburn
authors.forename: J
authors.initials: J
authors.lastname: O'Beirne
authors.forename: R S B
authors.initials: RS
authors.lastname: Milne
authors.forename: V C
authors.initials: VC
authors.lastname: Emery
authors.forename: P D
authors.initials: PD
authors.lastname: Griffiths
mesh_terms: D015415:Biomarkers; D003587:Cytomegalovirus / Q000502:physiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D016377:Organ Transplantation; D016133:Polymerase Chain Reaction; D019562:Viral Load; D014779:Virus Replication / Q000187:drug effects*
chemical_list: D015415:Biomarkers; D007166:Immunosuppressive Agents