Session Name: Kidney Infectious Non-Polyoma & Non-Viral Hepatitis
Session Date & Time: None. Available on demand.
*Purpose: Cytomegalovirus (CMV) is a significant cause of morbidity, mortality, and graft failure after solid organ transplantation, with high risk (D+/R-) patients being the highest risk for infection. While guidelines suggest using highly sensitive, quantitative NAT (QNAT) assays for CMV detection, they stipulate “there is no widely applicable viral load threshold to guide preemptive therapy”. This study evaluates the progression to CMV viremia following a CMV “blip” in high risk kidney/kidney-pancreas (KP) transplant recipients.
*Methods: This is a single center, retrospective study of CMV high risk kidney or KP transplant recipients from January 2015 – April 2020. A CMV “blip” was defined as a first positive QNAT assay below the level of quantification (< 1.37 x 102 IU/mL). Subsequent CMV QNAT assays were followed to assess the progression from blip to CMV viremia, syndrome, or tissue invasive disease. Outcomes were assessed for 1 year from the date of transplant and were evaluated using descriptive statistics and the chi-squared test.
*Results: One hundred thirty-four patients were included in the study. Fifty-three (39.6%) patients had their first positive CMV QNAT value below the level of quantification and were considered a CMV “blip”. Of these 53 patients, 69.8% (n=37) progressed to viremia while 30.2% (n=16) did not. The median time from transplant to the first CMV blip was 68 (46-97) days and the majority of blip patients (71.1%) were receiving anti-viral prophylaxis at the time of their blip. Median time from blip to CMV viremia was 19.5 (7-28) days. Low rates of CMV syndrome (7.5%) and resistant CMV (1.9%) were found in the blip population (n=53) or the overall population (n=134), 5.2% and 0.75% respectively. No differences were found when comparing patients who progressed from blip to viremia to those who only had a blip.
*Conclusions: In CMV high risk kidney/KP transplant recipients, CMV blips progressed to CMV viremia in the majority of cases. This progression typically occurred 2-3 weeks following the initial blip. Early CMV treatment or the development of monitoring protocols after blip identification could prevent the progression to CMV viremia or syndrome.
To cite this abstract in AMA style:Payne AT, Timpone JG, Gilbert A, Thomas B, Lindner BK. Unquantified Blips Lead to CMV Slips – Post Transplant CMV Monitoring in High Risk Kidney Transplant Recipients [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/unquantified-blips-lead-to-cmv-slips-post-transplant-cmv-monitoring-in-high-risk-kidney-transplant-recipients/. Accessed June 15, 2021.
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