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Differences of cytomegalovirus diseases between kidney and hematopoietic stem cell transplant recipients during preemptive therapy

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ABSTRACT

Background/aims:: Cytomegalovirus (CMV) surveillance and preemptive therapy is a widely-used strategy for preventing CMV disease in transplant recipients. However, there are limited data on the incidence and patterns of CMV disease during the preemptive period. Thus, we investigated the incidence and pattern of tissue-invasive CMV disease in CMV seropositive kidney transplantation (KT) and hematopoietic stem cell transplantation (HCT) recipients during preemptive therapy.

Methods:: We prospectively identified patients with tissue-invasive CMV disease among 664 KT (90%) and 496 HCT (96%) recipients who were D+/R+ (both donor and recipient seropositive) during a 4-year period.

Results:: The incidence rates of CMV disease were 4.1/100 person-years (4%, 27/664) in KT recipients and 5.0/100 person-years (4%, 21/496) in HCT recipients. Twenty-six (96%) of the KT recipients with CMV disease had gastrointestinal CMV, whereas 17 (81%) of the HCT recipients had gastrointestinal CMV and 4 (19%) had CMV retinitis. Thus, CMV retinitis was more common among HCT recipients (p = 0.03). All 27 KT recipients with CMV disease suffered abrupt onset of CMV disease before or during preemptive therapy; 10 (48%) of the 21 HCT recipients with CMV disease were also classified in this way but the other 11 (52%) were classified as CMV disease following successful ganciclovir preemptive therapy (p < 0.001).

Conclusions:: The incidence of CMV disease was about 4% in both KT and HCT recipients during preemptive therapy. However, CMV retinitis and CMV disease as a relapsed infection were more frequently found among HCT recipients.

No MeSH data available.


Pattern of tissue-invasive cytomegalovirus (CMV) disease in kidney (KT) recipients during preemptive therapy. A plain figure without borderline lying on the patient number means a type of preceding CMV antigenemia: a circle, no preceding CMV antigenemia; a triangle, preceding nonsignificant CMV antigenemia (< 50/200,000 cells); a rectangle, preceding significant CMV antigenemia (≥ 50/200,000 cells). A plain figure with a thick borderline means time of diagnosis and type of tissue-invasive CMV disease. Numbers written below plain figures of KTA1 and KTA2 means time of diagnosis of tissue-invasive CMV diseases developing more than 180 days post-KT.
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f1-kjim-2015-079: Pattern of tissue-invasive cytomegalovirus (CMV) disease in kidney (KT) recipients during preemptive therapy. A plain figure without borderline lying on the patient number means a type of preceding CMV antigenemia: a circle, no preceding CMV antigenemia; a triangle, preceding nonsignificant CMV antigenemia (< 50/200,000 cells); a rectangle, preceding significant CMV antigenemia (≥ 50/200,000 cells). A plain figure with a thick borderline means time of diagnosis and type of tissue-invasive CMV disease. Numbers written below plain figures of KTA1 and KTA2 means time of diagnosis of tissue-invasive CMV diseases developing more than 180 days post-KT.

Mentions: Of the enrolled recipients, 27 KT recipients (4%, incidence rate 4.1/100 person-years; 95% confidence interval [CI], 2.7 to 6.0) and 21 HCT recipients (4%, incidence rate 5.0/100 person-years; 95% CI, 3.1 to 7.7) developed tissue-invasive CMV disease (p = 0.49). Median absolute neutrophil count (ANC) at the time of CMV tissue was lower in HCT recipients (2,332 µ/L; interquartile range [IQR], 2,645 to 5,333) than that in KT recipients (3,771 µ/L; IQR, 2,645 to 5,333; p = 0.012). But, only one recipient had less than 1,000 µ/L ANC in both groups, respectively (Table 1). Median post-transplant days at the onset of CMV disease in the KT recipients and HCT recipients were 51 (IQR, 35 to 88) and 60 (IQR, 40 to 115; p = 0.30) (Table 1). Four KT recipients (15%) and eight HCT recipients (38%) had their first episode of CMV disease > 100 days post-transplantation (p = 0.10). Two KT recipients (7%) and none of the HCT recipients had their first episode > 180 days post-transplantation (p = 0.50). Of 27 KT recipients with CMV disease, 26 (96%) had gastrointestinal disease, whereas, of the 21 HCT recipients with CMV disease, 17 (81%) had gastrointestinal CMV diseases and four (19%) had CMV retinitis (Figs. 1 and 2). Thus, CMV retinitis was more frequent in the HCT recipients (p = 0.03) (Table 1).


Differences of cytomegalovirus diseases between kidney and hematopoietic stem cell transplant recipients during preemptive therapy
Pattern of tissue-invasive cytomegalovirus (CMV) disease in kidney (KT) recipients during preemptive therapy. A plain figure without borderline lying on the patient number means a type of preceding CMV antigenemia: a circle, no preceding CMV antigenemia; a triangle, preceding nonsignificant CMV antigenemia (< 50/200,000 cells); a rectangle, preceding significant CMV antigenemia (≥ 50/200,000 cells). A plain figure with a thick borderline means time of diagnosis and type of tissue-invasive CMV disease. Numbers written below plain figures of KTA1 and KTA2 means time of diagnosis of tissue-invasive CMV diseases developing more than 180 days post-KT.
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC5016278&req=5

f1-kjim-2015-079: Pattern of tissue-invasive cytomegalovirus (CMV) disease in kidney (KT) recipients during preemptive therapy. A plain figure without borderline lying on the patient number means a type of preceding CMV antigenemia: a circle, no preceding CMV antigenemia; a triangle, preceding nonsignificant CMV antigenemia (< 50/200,000 cells); a rectangle, preceding significant CMV antigenemia (≥ 50/200,000 cells). A plain figure with a thick borderline means time of diagnosis and type of tissue-invasive CMV disease. Numbers written below plain figures of KTA1 and KTA2 means time of diagnosis of tissue-invasive CMV diseases developing more than 180 days post-KT.
Mentions: Of the enrolled recipients, 27 KT recipients (4%, incidence rate 4.1/100 person-years; 95% confidence interval [CI], 2.7 to 6.0) and 21 HCT recipients (4%, incidence rate 5.0/100 person-years; 95% CI, 3.1 to 7.7) developed tissue-invasive CMV disease (p = 0.49). Median absolute neutrophil count (ANC) at the time of CMV tissue was lower in HCT recipients (2,332 µ/L; interquartile range [IQR], 2,645 to 5,333) than that in KT recipients (3,771 µ/L; IQR, 2,645 to 5,333; p = 0.012). But, only one recipient had less than 1,000 µ/L ANC in both groups, respectively (Table 1). Median post-transplant days at the onset of CMV disease in the KT recipients and HCT recipients were 51 (IQR, 35 to 88) and 60 (IQR, 40 to 115; p = 0.30) (Table 1). Four KT recipients (15%) and eight HCT recipients (38%) had their first episode of CMV disease > 100 days post-transplantation (p = 0.10). Two KT recipients (7%) and none of the HCT recipients had their first episode > 180 days post-transplantation (p = 0.50). Of 27 KT recipients with CMV disease, 26 (96%) had gastrointestinal disease, whereas, of the 21 HCT recipients with CMV disease, 17 (81%) had gastrointestinal CMV diseases and four (19%) had CMV retinitis (Figs. 1 and 2). Thus, CMV retinitis was more frequent in the HCT recipients (p = 0.03) (Table 1).

View Article: PubMed Central - PubMed

ABSTRACT

Background/aims:: Cytomegalovirus (CMV) surveillance and preemptive therapy is a widely-used strategy for preventing CMV disease in transplant recipients. However, there are limited data on the incidence and patterns of CMV disease during the preemptive period. Thus, we investigated the incidence and pattern of tissue-invasive CMV disease in CMV seropositive kidney transplantation (KT) and hematopoietic stem cell transplantation (HCT) recipients during preemptive therapy.

Methods:: We prospectively identified patients with tissue-invasive CMV disease among 664 KT (90%) and 496 HCT (96%) recipients who were D+/R+ (both donor and recipient seropositive) during a 4-year period.

Results:: The incidence rates of CMV disease were 4.1/100 person-years (4%, 27/664) in KT recipients and 5.0/100 person-years (4%, 21/496) in HCT recipients. Twenty-six (96%) of the KT recipients with CMV disease had gastrointestinal CMV, whereas 17 (81%) of the HCT recipients had gastrointestinal CMV and 4 (19%) had CMV retinitis. Thus, CMV retinitis was more common among HCT recipients (p = 0.03). All 27 KT recipients with CMV disease suffered abrupt onset of CMV disease before or during preemptive therapy; 10 (48%) of the 21 HCT recipients with CMV disease were also classified in this way but the other 11 (52%) were classified as CMV disease following successful ganciclovir preemptive therapy (p &lt; 0.001).

Conclusions:: The incidence of CMV disease was about 4% in both KT and HCT recipients during preemptive therapy. However, CMV retinitis and CMV disease as a relapsed infection were more frequently found among HCT recipients.

No MeSH data available.