Prevention of cytomegalovirus disease using preemptive treatment after solid organ transplant in patients at high risk for cytomegalovirus infection

• Published in: Antiviral therapy Vol. 14; no. 5; pp. 641 - 647
• Main Authors: BENMARZOUK-HIDALGO, Omar Jesus, CORDERO, Elisa, MARTIN-PENA, Almudena, GARCIA-PRODO, Elena, GENTIL, Miguel Angel, GOMEZ-BRAVO, Miguel Angel, BARRERA-PULIDO, Lydia, CISNEROS, Jose Miguel, PEREZ-ROMERO, Pilar
• Format: Journal Article
• Language: English
• Published: London International Medical Press 01.07.2009
• Subjects: Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiviral agents; Biological and medical sciences; Cytomegalovirus; Infectious diseases; Medical sciences; Pharmacology. Drug treatments; Viral diseases; Disease; Herpesviridae; Exploration; Transplantation; Real time; Betaherpesvirinae; Human cytomegalovirus; Infection; Virus; Prevention; Polymerase chain reaction; Treatment; Viral disease
• ISSN: 1359-6535; 2040-2058
• DOI: 10.1177/135965350901400509

Background The use of pre-emptive or prophylactic treatment to control cytomegalovirus (CMV) replication after solid organ transplant (SOT) remains controversial. The aim of this study was to evaluate whether administration of pre-emptive treatment to control viral replication guided by a highly sensitive diagnostic tool is an effective approach for preventing CMV disease, even in high-risk transplant recipients. Methods Plasma samples from eight SOT patients were tested using antigenaemia and real-time PCR (RT-PCR) assays. Pre-emptive treatment was administered guided by RT-PCR when viral load values were >1,000 copies/ml. Results All patients developed episodes of CMV infection, but none of them developed CMV disease or indirect effects. No patient in this study died or experienced graft rejection. Treatment was needed in 10 replication episodes. At the end of treatment, four had undetectable levels and the other six were cleared 3 weeks later. In 42.6% of tested samples RT-PCR was more sensitive for detecting viral infection. Conclusions Pre-emptive monitoring of SOT patients at high risk for CMV infection protected patients from developing CMV disease during the first 6 months after transplant. The use of this sensitive method for guiding pre-emptive treatment diminished viral load early enough that it did not have consequences for patient health.