Impact and Outcomes of Primary Cytomegalovirus Infection in Seronegative Abdominal Solid Organ Transplant Recipients of Cytomegalovirus Unexposed Donors (D-/R-)

M. Jorgenson¹, M. Hillis¹, N. Friedlander¹, A. Gracon², D. Yang², G. Leverson², J. Smith², R. Redfield²

¹UWHC, Madison, WI, ²UWMF, Madison, WI

Meeting: 2020 American Transplant Congress

Abstract number: C-196

Keywords: Cytomeglovirus, Liver transplantation, Outcome, Pancreas transplantation

Session Information

Session Name: Poster Session C: Kidney Infectious Excluding Polyoma & Viral Hepatitis

Session Type: Poster Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:00pm

Presentation Time: 3:30pm-4:00pm

Location: Virtual

*Purpose: Primary cytomegalovirus infection (CMV) in high risk (D+/R-) abdominal solid organ transplant recipients (aSOTRs) is well described, however there is a paucity of literature evaluating outcomes after CMV in low risk (D-/R-) patients.

*Methods: Adult patients receiving a aSOTR (kidney, liver, pancreas or any combination) between 1/1/2009-9/1/2019 at our institution were screened based on serostatus; D-/R- and D+/R- patients were included. Primary objective: Epidemiology of primary CMV in D-/R-. Secondary objective: Infectious and transplant related outcomes of primary CMV in the first 90 days (CMV90) in D-/R- vs D+/R-

*Results: There were 782 D-/R- aSOTRs in the study period; 13 D-/R- patients developed CMV. In comparison there were 671 D+/R- patients in the study period; 186 developed CMV. D-/R- patients with CMV had a median peak viral load (VL) of 468,000 IU/mL, 69.2% of patients required hospitalization and 100% required immunosuppressive modification. Additionally, 30.8% of D-/R- CMV was complicated by a concomitant opportunistic infection and 23% developed resistance. These factors were similar to findings in D+/R-, however D-/R- had significantly higher incidence of end organ disease (61.5% vs 20.7%, p=0.015). Of the 13 D-/R- patients who developed CMV, 7 were CMV90 (54%). Of the 186 D+/R- patients who developed CMV, 29 were CMV90 (15.6%) p=0.0005. The CMV90 populations were similar demographically, including allograft subtype. When evaluating transplant outcomes D-/R- was protective against rejection (HR 0.7, 95% CI 0.6-1.0, p=0.06) and development of CMV in either group increased risk of rejection (HR 2.8, 95% CI 1.5-5.5, p=0.002). When assessing the impact of development of CMV90 on rejection; D-/R- remained protective (HR 0.58, 95% CI 0.074-4.62, p=0.0012) when compared to D+/R-. However, risk of graft loss was significantly higher in the setting of CMV90 in D-/R- (HR 4.7, 95% CI 1.22-18.33, p=0.026). Mortality risk was also significantly higher (HR 4.5, 95% CI 0.871-23.3, p=0.048)

*Conclusions: Low risk aSOTRs infrequently develop CMV, however when it occurs, they present with disease manifestations similar to or more severe than their high risk counterparts including high VL, end organ sequelae, and frequently require hospitalization, prolonged antiviral therapy, and immunosuppressive modification. CMV in D-/R- is also associated with increased risk of antiviral resistance, graft loss and mortality. This severity suggests primary disease, rather than reactivation. The majority of CMV in D-/R- occurs in the first 90 days after transplant, suggesting possible subclinical infection in the donor or a transfusion source. The complicated CMV course in D-/R- can likely be attributed to low clinical suspicion for CMV infection. Awareness of disease severity in D-/R- and aggressive upfront management may promote positive outcomes.

To cite this abstract in AMA style:

Jorgenson M, Hillis M, Friedlander N, Gracon A, Yang D, Leverson G, Smith J, Redfield R. Impact and Outcomes of Primary Cytomegalovirus Infection in Seronegative Abdominal Solid Organ Transplant Recipients of Cytomegalovirus Unexposed Donors (D-/R-) [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/impact-and-outcomes-of-primary-cytomegalovirus-infection-in-seronegative-abdominal-solid-organ-transplant-recipients-of-cytomegalovirus-unexposed-donors-d-r/. Accessed November 22, 2024.

« Back to 2020 American Transplant Congress