Table 1.
Viral replication kinetics, incidence rates, and severity of CMV disease in solid organ transplant recipients
| Parameter | Value or descriptiona |
|||
|---|---|---|---|---|
| CMV D+/R− SOT recipients |
CMV R+ SOT recipients |
|||
| Viral replication kinetics (units/day) (mean [95% CI]) | 1.82 (1.44–2.56) | 0.61 (0.55–0.7) | ||
| Viral doubling time (days) (mean [range]) | 1.54 (0.5–5.5) | 2.67 (0.27–26.7) | ||
| Viral load at time of CMV disease diagnosis (absolute values dependent on specific viral load assay) | High to very high | Low to high | ||
| Severity of CMV disease | Often moderate to severe | Often mild to moderate | ||
| Incidence (%) of CMV disease in SOT organ | No prophylaxis | With prophylaxisb | No prophylaxis | With prophylaxisb |
| Kidney and/or pancreas | 45–65 | 6–38 | 8–20 | 1–2 |
| 17* | ||||
| Liver | 45–65 | 6–29 | 8–19 | 4–6 |
| Heart | 29–74 | 19–30 | 20–40 | 2 |
| Lung and lung-heart | 50–91 | 32 | 35–59 | 32 |
| 10* | <5–10* | |||
| 4** | 4** | |||
| Small bowel (intestinal) | LD | 7–37 | LD | 7–44 |
| Composite tissue (hand/face) | LD | 66–100 (LD) | LD | 45 (LD) |
The risk of CMV disease is higher (i.e., rates at the higher end of the reported range) for CMV D+/R+ patients than for CMV D−/R+ solid organ transplant recipients. Rates are estimates based on a review of clinical trials and retrospective and prospective clinical studies. LD, limited data are available for intestinal and composite tissue transplant recipients. Data were gathered from references 3 and 29 to 43.
Prophylaxis is given for a duration of 3 months unless otherwise indicated. *, 6 months of prophylaxis; **, 12 months of prophylaxis after lung transplantation. CMV disease in patients who receive prophylaxis generally occurs after the completion of antiviral prophylaxis (delayed-onset CMV disease).