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

Luciano Potena, Cecile T.J. Holweg, Marcy L. Vana, Leena Bashyam, Jaya Rajamani, A. Louise McCormick, John P. Cooke, Hannah A. Valantine, Edward S. Mocarski

Research output: Contribution to journalArticle

23 Scopus citations

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/105 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.

Original languageEnglish (US)
Pages (from-to)1804-1810
Number of pages7
JournalJournal of Clinical Microbiology
Volume45
Issue number6
DOIs
StatePublished - Jun 2007

ASJC Scopus subject areas

  • Microbiology (medical)

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