Clinical utility of cytomegalovirus (CMV) serology testing in high-risk CMV D+/R- transplant recipients

Atul Humar, Tony Mazzulli, George Moussa, Raymund R Razonable, Carlos V. Paya, Mark D. Pescovitz, Emma Covington, Emma Alecock

Research output: Contribution to journalArticle

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Abstract

Late-onset cytomegalovirus (CMV) disease is a significant problem in D+/R- solid organ transplant (SOT) patients who receive antiviral prophylaxis. We assessed the clinical utility of CMV IgG and IgM serology testing for predicting late-onset CMV disease. We evaluated 352 D+/R- transplant recipients who participated in a trial comparing 100 days of ganciclovir versus valganciclovir prophylaxis. CMV serology was assessed on day 28, 56, 100, and 6 and 12 months post-transplant. IgG seroconversion occurred in 26.9% of patients by day 100, and in 63.4% and 75.3% by 6 and 12 months, respectively. IgM seroconversion occurred in 8.3%, 41.8% and 54.9% by day 100, month 6 and month 12, respectively. Seroconversion by day 100 (end of prophylaxis) was not predictive of subsequent CMV disease (CMV disease 13.3% if seropositive vs. 17.8% if seronegative; p = NS). However, at 6 months post-transplant, IgG serostatus was predictive of subsequent CMV disease between month 6 and 12 (CMV disease 1.3% if seropositive vs. 10.0% if seronegative; p = 0.002). In D+/R- patients, CMV serology testing is for the most part not clinically useful for predicting subsequent disease. However, seroconversion by 6 months may be useful for identifying patients at risk of late-onset CMV disease.

Original languageEnglish (US)
Pages (from-to)1065-1070
Number of pages6
JournalAmerican Journal of Transplantation
Volume5
Issue number5
DOIs
StatePublished - May 2005

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Serology
Cytomegalovirus
Immunoglobulin G
Transplants
Immunoglobulin M
Transplant Recipients
Ganciclovir
Antiviral Agents
Seroconversion

Keywords

  • Cytomegalovirus
  • Ganciclovir
  • Serology
  • Solid organ transplant
  • Valganciclovir

ASJC Scopus subject areas

  • Immunology

Cite this

Clinical utility of cytomegalovirus (CMV) serology testing in high-risk CMV D+/R- transplant recipients. / Humar, Atul; Mazzulli, Tony; Moussa, George; Razonable, Raymund R; Paya, Carlos V.; Pescovitz, Mark D.; Covington, Emma; Alecock, Emma.

In: American Journal of Transplantation, Vol. 5, No. 5, 05.2005, p. 1065-1070.

Research output: Contribution to journalArticle

Humar, Atul ; Mazzulli, Tony ; Moussa, George ; Razonable, Raymund R ; Paya, Carlos V. ; Pescovitz, Mark D. ; Covington, Emma ; Alecock, Emma. / Clinical utility of cytomegalovirus (CMV) serology testing in high-risk CMV D+/R- transplant recipients. In: American Journal of Transplantation. 2005 ; Vol. 5, No. 5. pp. 1065-1070.
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abstract = "Late-onset cytomegalovirus (CMV) disease is a significant problem in D+/R- solid organ transplant (SOT) patients who receive antiviral prophylaxis. We assessed the clinical utility of CMV IgG and IgM serology testing for predicting late-onset CMV disease. We evaluated 352 D+/R- transplant recipients who participated in a trial comparing 100 days of ganciclovir versus valganciclovir prophylaxis. CMV serology was assessed on day 28, 56, 100, and 6 and 12 months post-transplant. IgG seroconversion occurred in 26.9{\%} of patients by day 100, and in 63.4{\%} and 75.3{\%} by 6 and 12 months, respectively. IgM seroconversion occurred in 8.3{\%}, 41.8{\%} and 54.9{\%} by day 100, month 6 and month 12, respectively. Seroconversion by day 100 (end of prophylaxis) was not predictive of subsequent CMV disease (CMV disease 13.3{\%} if seropositive vs. 17.8{\%} if seronegative; p = NS). However, at 6 months post-transplant, IgG serostatus was predictive of subsequent CMV disease between month 6 and 12 (CMV disease 1.3{\%} if seropositive vs. 10.0{\%} if seronegative; p = 0.002). In D+/R- patients, CMV serology testing is for the most part not clinically useful for predicting subsequent disease. However, seroconversion by 6 months may be useful for identifying patients at risk of late-onset CMV disease.",
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