Two-year analysis of prospective CMV-PCR surveillance data in lung transplant recipients
Abstract number: 1134_03_405
Harwood J., Krause A., Gould K., Dark J., Corris P.
CMV is a major cause of mortality and morbidity in transplant (tx) recipients. We commence weekly Quantitative CMV PCR (QPCR) surveillance on our CMV positive (+) recipients four weeks post-tx for three months. The CMV mismatch (MM) recipients commence weekly QPCR for three months, two weeks after the cessation of prophylactic ganciclovir (GCV), which is given for the first three months post-tx in this group. CMV ( recipients receive no prophylaxis. During the surveillance period, pre-emptive therapy (Rx) with oral GCV is given if QPCR is (1 × 104 copies/ml and the patient is asymptomatic. IV GCV is given in symptomatic patients above this cut-off.
1. To estblish whether there is a correlation between clinical symptoms associated with CMV disease and the viral load of CMV. 2. To review the present viral load cut-off above which pre-emptive Rx is considered in asymptomatic patients to prevent development of disease.
We conducted a prospective analysis of patients' notes who underwent lung tx between Novemeber 2001 and November 2003. Thirty eight patients (>18 years) and one patient (<18 years) who survived six months were included in the study.
Of all the patients, six remained QPCR negative throughout the study (3 CMV MM, 3 CMV+). Twelve patients had low level QPCR levels, 103104 copies/ml, of which one MM patient developed symptoms and required pre-emtpive Rx. Eleven patients had QPCR levels of 104105 copies/ml, of which 4 (1 MM, 3 CMV+) received IV GCV for symptomatic disease. Nine patients had QPCR levels (105 copies/ml (4MM, 5 CMV+) of which 3 received treatment for symptomatic disease.
We did not find any association between viral load level and development of CMV disease. Only 9 patients developed CMV disease requiring treatment, whereas 23 patients had raised QPCR levels with no disease. This data suggests that our current cut off of (104 copies/ml is appropriate for the initiation of pre-emptive therapy in asymptomatic patients and is effective in preventing disease.
|Session name:||XXIst ISTH Congress|
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