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Infection and reactivation with cytomegalovirus strains in lung transplant recipients
R L Smyth1, J Sinclair, J P Scott
1Department of Medicine, Addenbrooke's Hospital, Cambridge, England.
Abstract:
Cytomegalovirus pneumonia is a major cause of morbidity and death following lung transplantation (LT) (1). The case fatality rate is highest in the CMV-seronegative recipients (R-) of organs from seropositive donors (D+), which suggests that transmission of CMV may occur with the graft (1), but in seropositive recipients (R+) the comparative importance of reactivation of endogenous virus and reinfection with donor virus is poorly understood.
Insights
Cytomegalovirus pneumonia poses a significant risk after lung transplantation. Understanding if the virus is reactivated or reinfected in CMV-seropositive recipients is crucial for improving outcomes.
Area of Science:
- Medicine
- Transplantation Immunology
- Infectious Diseases
Background:
- Cytomegalovirus (CMV) pneumonia is a leading cause of death post-lung transplantation (LT).
- The highest fatality rates are observed in CMV-seronegative recipients receiving organs from CMV-seropositive donors, suggesting graft transmission.
- The origins of CMV infection in CMV-seropositive lung transplant recipients (endogenous reactivation vs. exogenous reinfection) remain unclear.
Purpose of the Study:
- To investigate the sources of Cytomegalovirus infection in lung transplant recipients.
- To differentiate between CMV reactivation and reinfection in seropositive recipients post-lung transplantation.
Main Methods:
- Analysis of patient serostatus (donor/recipient) and clinical outcomes.
- Potential molecular assays to distinguish between endogenous and exogenous CMV strains (details not provided in abstract).
Main Results:
- CMV pneumonia is a critical complication following lung transplantation.
- A higher case fatality rate is noted in CMV-seronegative recipients from seropositive donors, indicating transmission via the graft.
- The relative contributions of endogenous reactivation versus donor-derived reinfection in CMV-seropositive recipients require further elucidation.
Conclusions:
- Cytomegalovirus pneumonia significantly impacts lung transplant outcomes.
- Graft transmission is a key factor in CMV-seronegative recipients.
- Further research is needed to clarify the roles of reactivation and reinfection in seropositive lung transplant recipients.