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KMID : 0338420160310050961
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The Korean Journal of Internal Medicine
2016 Volume.31 No. 5 p.961 ~ p.970
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Differences of cytomegalovirus diseases between kidney and hematopoietic stem cell transplant recipients during preemptive therapy
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Kim Tark
Lee Yu-Mi
Lee Sang-Oh
Choi Sang-Ho
Kim Yang-Soo
Woo Jun-Hee
Sung Heung-Sup
Jung Joo-Hee
Shin Sung
Kim Young-Hoon
Kang Young-Ah
Lee Young-Shin
Lee Jung-Hee
Lee Je-Hwan
Lee Kyoo-Hyung
Park Su-Kil
Han Duck-Jong
Kim Sung-Han
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Abstract
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Background/Aims: Cytomegalovirus (CMV) surveillance and preemptive therapy is a widely-used strategy for preventing CMV disease in transplant recipients. However, there are limited data on the incidence and patterns of CMV disease during the preemptive period. Thus, we investigated the incidence and pattern of tissue-invasive CMV disease in CMV seropositive kidney transplantation (KT) and hematopoietic stem cell transplantation (HCT) recipients during preemptive therapy.
Methods: We prospectively identified patients with tissue-invasive CMV disease among 664 KT (90%) and 496 HCT (96%) recipients who were D+/R+ (both donor and recipient seropositive) during a 4-year period.
Results: The incidence rates of CMV disease were 4.1/100 person-years (4%, 27/664) in KT recipients and 5.0/100 person-years (4%, 21/496) in HCT recipients. Twenty-six (96%) of the KT recipients with CMV disease had gastrointestinal CMV, whereas 17 (81%) of the HCT recipients had gastrointestinal CMV and 4 (19%) had CMV retinitis. Thus, CMV retinitis was more common among HCT recipients (p = 0.03). All 27 KT recipients with CMV disease suffered abrupt onset of CMV disease before or during preemptive therapy; 10 (48%) of the 21 HCT recipients with CMV disease were also classified in this way but the other 11 (52%) were classified as CMV disease following successful ganciclovir preemptive therapy (p < 0.001).
Conclusions: The incidence of CMV disease was about 4% in both KT and HCT recipients during preemptive therapy. However, CMV retinitis and CMV disease as a relapsed infection were more frequently found among HCT recipients.
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KEYWORD
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Cytomegalovirus, Prophylaxis, Kidney transplantation, Hematopoietic stem cell transplantation
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