Table 1.
Characteristics of transplant recipients at the time of transplantation and clinical parameters of subsequent CMV infection, according to type of transplantation.
| All recipients | Type of transplantation |
p-Value | ||
|---|---|---|---|---|
| Solid organ | Bone marrow | |||
| Patient characteristics at the time of transplantation | ||||
| Demographics | ||||
| Number (%) of recipients | 193 (100%) | 74/193 (38%) | 119/193 (62%) | |
| Median age (IQR), years | 46 (32–58) | 51.5 (38–59) | 45 (23–56) | 0.03 |
| Gender (% male) | 133/193 (69%) | 48/74 (65%) | 85/119 (71%) | 0.3 |
| Risk of CMV infection1 | ||||
| Number of recipients at high risk of CMV infection | 96/193 (50%) | 34/74 (46%) | 62/119 (52%) | 0.5 |
| Number of recipients at intermediary/low risk of CMV infection | 97/193 (50%) | 40/74 (54%) | 57/119 (48%) | 0.6 |
| Factors describing CMV infection | ||||
| CMV infection | ||||
| Median time-span from tx to the V1 sample2 (IQR), days | 55 (42–105) | 109 (46–151) | 50 (40–61) | < 0.0001 |
| Median time-span from the V1 sample to Vpeak sample2 (IQR), days | 7 (4–11) | 7 (5–11) | 7 (4–11) | 0.4 |
| Median viral load (IU/mL), V1 sample (IQR) | 1183 (546–3913) | 1183 (455–8099) | 1183 (601–3367) | 0.6 |
| Median viral load (IU/mL) of Vpeak sample (IQR) | 5460 (1820–26,390) | 9965 (1911–40,040) | 4550 (1729–15,470) | 0.05 |
| Anti-CMV treatment | ||||
| Strategy for prevention of CMV disease | 3 months prophylaxis + preemptive treatment | Preemptive treatment | ||
| Number of patients not receiving treatment during the period of infection used for calculation of doubling time3 | 56/193 (29%) | 29/74 (39%) | 27/119 (23%) | 0.01 |
| Number of patients experiencing infectious breakthrough during prophylaxis or treatment | 21/193 (11%) | 15/74 (20%)4A | 6/119 (5%)4B | 0.002 |
| Median proportion of time during CMV infection on treatment (IQR)3 | 50% (0–80%) | 18% (0–85%) | 57% (0–80%) | 0.1 |
| Symptomatic CMV infection5 | ||||
| Number of patients with symptomatic CMV infection | 59/188a (31%) | 33/74 (45%) | 26/114a (23%) | 0.002 |
| Risk factors for development of CMV infection | ||||
| Allograft rejection or graft versus host disease6 | 36/193 (19%) | 8/74 (11%) | 28/119 (24%) | 0.04 |
Abbreviations: CMV; cytomegalovirus, tx; transplantation, IQR; interquartile range.
Risk of CMV infection according to donor (D)/recipient (R) CMV IgG serostatus (+/−) at the time of transplantation. For solid organ transplantation recipients D +/R − is associated with high risk of CMV infection, while D −/R + is associated with low risk. Among bone marrow transplant recipients, D −/R + is associated with a high risk of CMV infection, whereas D +/R − is associated with a low risk. For both types of transplantation, D +/R + is associated with intermediary risk of CMV infection. Due to the low number of low risk patients in our cohort (N = 13), intermediary and low risk patients are grouped together in this table.
V1 is the first positive CMV PCR of the infectious episode, Vpeak is the highest measured CMV PCR sample within 14 days of V1.
When calculating CMV doubling time, the V1 sample and the Vpeak sample, are used. Based on this time span, the proportion of time during CMV infection on treatment has been determined for each patient.
A. Of these, 10 kidney- and two lung recipients had prophylaxis breakthrough; for one lung and two kidney recipients treatment was initiated before confirmation of positive CMV PCR due to strong clinical suspicion of CMV infection. B. The latter was also the case for the six HSCT patients.
Defined as either CMV syndrome (fever, leukopenia or malaise due to CMV infection) or CMV disease (pneumonia, enteritis, hepatitis, encephalitis or retinitis verified to be caused by CMV).
Allograft rejection or graft versus host disease confirmed with biopsy within 30 days prior to the first positive CMV PCR to the date of the highest measured CMV PCR.
For five HSCT recipients, these data were unavailable.