Frequent occult infection with cytomegalovirus in cardiac transplant recipients despite antiviral prophylaxis

• Type of Material: Article
• Authors: Luciano Potena, Stanford University School of Medicine; Cecile T. J. Holweg, Stanford University School of Medicine; Marcy L. Vana, Stanford University School of Medicine; Leena Bashyam, Stanford University School of Medicine; Jaya Rajamani, Stanford University School of Medicine; Anita McCormick, Emory University; John P. Cooke, Stanford University School of Medicine; Hannah A. Valantine, Stanford University School of Medicine; Edward Mocarski, Emory University
• Language: English
• Date: 2007-06-01
• Publisher: American Society for Microbiology
• Publication Version: Final Published Version
• Copyright Statement: © 2007, American Society for Microbiology. All Rights Reserved.
• Final Published Version (URL): http://dx.doi.org/10.1128/JCM.01362-06
• Title of Journal or Parent Work: Journal of Clinical Microbiology
• ISSN: 0095-1137
• Volume: 45
• Issue: 6
• Start Page: 1804
• End Page: 1810
• Grant/Funding Information: This work was supported by a PHS program project grant (PO1 AI50153) to E.S.M., J.P.C., and H.A.V. as well as by a fellowship from the Italian Society of Cardiology (to L.P.).
• Keywords: REJECTION; IMPACT; Science & Technology; Microbiology; REPLICATION; CMV DISEASE; Life Sciences & Biomedicine; MICROBIOLOGY; GANCICLOVIR; PREVENTION
• Research Categories: Health Sciences, Immunology; Biology, Microbiology

Abstract

Despite antiviral prophylaxis, a high percentage (over 90%) of heart transplant patients experience active cytomegalovirus (CMV) infection, diagnosed by detection of viral DNA in peripheral blood polymorphonuclear leukocytes within the first few months posttransplantation. Viral DNA was detected in mononuclear cells prior to detection in granulocytes from CMV-seropositive recipients (R + ) receiving a heart from a CMV-seropositive donor (D + ). Based on assessment of systemic infection in leukocyte populations, both R + subgroups (R + /D - and R + /D + ) experienced a greater infection burden than the R - /D + subgroup, which was aggressively treated because of a higher risk of acute CMV disease. Despite widespread systemic infection in all at-risk patient subgroups, CMV DNA was rarely ( < 3% of patients) detected in transplanted heart biopsy specimens. The R + patients more frequently exceeded the 75th percentile of the CMV DNA copy number distribution in leukocytes (110 copies/10 5 polymorphonuclear leukocytes) than the R - /D + subgroup. Therefore, active systemic CMV infection involving leukocytes is common in heart transplant recipients receiving prophylaxis to reduce acute disease. Infection of the transplanted organ is rare, suggesting that chronic vascular disease attributed to CMV may be driven by the consequences of systemic infection.