Purpose: The purpose of this study was to evaluate the timeliness of assessment of positive cytomegalovirus (CMV) polymerase chain reaction (PCR) results. This study served to assess the impact the timeliness of treatment initiation on clinical outcomes, specifically CMV related hospital admissions within 90 days of a positive PCR.

Methods: This single-institution retrospective study included adult patients who received an abdominal organ transplant at our institution between 2011 and 2013 and had a positive CMV PCR within eighteen months of transplant. Patients were divided into early and late treatment groups. The early treatment group was defined as those who received CMV therapy within seven days of a reported positive CMV PCR, whereas the late treatment group did not receive therapy within seven days after the PCR was collected. The primary analysis compared rates of CMV-related hospital admissions within three months of a positive CMV PCR. The following secondary endpoints were also compared: difference in overall number of hospital admissions, incidence of acute rejection, rates of ganciclovir-resistant CMV infection, and time to first negative CMV PCR.

Results: 355 cases of CMV within 18 months of transplant were identified in 221 patients. 238 of the CMV cases were treated within 7 days of a positive test, while 117 were not treated within 7 days. The median initial viral load in the early treatment group was 530 copies/mL, while the mean initial viral load in the late treatment group was “low positive”. Of the early treatment group, 7.6% of cases were associated with a CMV-related hospital admission within 90 days compared to 9.4% in the late treatment group (p=0.52). The median time from treatment initiation to negative PCR was 33 days in the early treatment group versus 38 days in the late treatment group (p=0.052). There were no statistically significant differences for the secondary endpoints that were investigated.

Conclusion: We were unable to identify a clinically significant impact of delayed CMV treatment in this study. Based on our findings, it appeared that patients with low PCR values did not suffer from a delay in therapy. Therefore, in some circumstances, it may be appropriate to continue to monitor PCR before initiating CMV treatment. Our institution has elected to pursue CMV treatment initiation based on a PCR of > 1000 copies/mL for CMV IgG seropositive recipients and for any positive PCR for CMV IgG seronegative recipients.

CITATION INFORMATION: Roach K, Triemer H, Hurtik M, Mehta A. Impact of Timeliness of Assessment of Positive Cytomegalovirus Polymerase Chain Reaction Results in Abdominal Organ Transplant Recipients. Am J Transplant. 2017;17 (suppl 3).

« Back to 2017 American Transplant Congress