title: Human cytomegalovirus end-organ disease is associated with high or low systemic viral load in preemptively treated solid-organ transplant recipients.
abstract: Human cytomegalovirus (HCMV) end-organ disease in solid-organ transplant recipients (SOTR) may be associated with either high or low HCMV load in blood. In transplantation Centers where the preemptive therapy approach is adopted, antiviral therapy of systemic HCMV infections is initiated upon reaching pre-determined cut-off levels of viral DNA in blood, whereas no guidelines are provided for local end-organ infection/disease. In the latter case, clinicians often start antiviral treatment without defining the etiology of local symptoms. Here, we describe 14 cases of SOTR, in which a documented HCMV end-organ disease was observed. Nine patients had a systemic viral load lower than the cut-off for preemptive therapy and were treated based on viral load of local HCMV disease. The remaining five patients had a systemic viral load greater than the preemptive therapy cut-off and were efficiently treated for both the systemic and the local HCMV disease. Thus, HCMV infection in the post-transplant period must be monitored virologically both in blood and locally. End-organ disease in preemptively treated patients, seems to be associated with lack of development (primary HCMV infection) or reconstitution (reactivated infection) of HCMV-specific CD4+ and CD8+ T-cell immunity or with its functional impairment.
authors: Laboratori Sperimentali di Ricerca, Area Trapiantologica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. g.gerna@smatteo.pv.it
authors: Giuseppe
authors: G
authors: Gerna
authors: Daniele
authors: D
authors: Lilleri
authors: Milena
authors: M
authors: Furione
authors: Barbara
authors: B
authors: Castiglioni
authors: Federica
authors: F
authors: Meloni
authors: Teresa
authors: T
authors: Rampino
authors: Manuela
authors: M
authors: Agozzino
authors: Eloisa
authors: E
authors: Arbustini
mesh_terms: D000328:Adult; D001706:Biopsy; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology / Q000821:virology; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology / Q000821:virology; D003587:Cytomegalovirus / Q000276:immunology / Q000472:pathogenicity*; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology / Q000821:virology; D004279:DNA, Viral / Q000097:blood*; D005260:Female; D015774:Ganciclovir / Q000494:pharmacology; D006801:Humans; D007111:Immunity, Cellular; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation; D012016:Reference Values; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult
chemical_list: D004279:DNA, Viral; D015774:Ganciclovir