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Cytomegalovirus infections in heart and heart and lung transplant recipients
T G Wreghitt1, M Hakim, J J Gray
1Clinical Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Cambridge.
Insights
Cytomegalovirus (CMV) infection is common after heart and lung transplants, with 45% of patients developing it. Primary CMV infection poses the greatest risk, especially when organs come from CMV-positive donors.
Area of Science:
- Transplant Medicine
- Infectious Diseases
- Immunology
Background:
- Cytomegalovirus (CMV) infection is a significant post-transplant complication.
- Organ transplantation, particularly heart and lung transplants, carries a risk of CMV transmission and reactivation.
Purpose of the Study:
- To investigate the incidence and impact of cytomegalovirus (CMV) infection in heart and lung transplant recipients.
- To identify risk factors and prognostic indicators for CMV infection post-transplantation.
Main Methods:
- Serological methods were used to investigate CMV infection in 162 transplant recipients.
- Analysis included primary infection, reactivation/reinfection, and correlation with donor-recipient CMV antibody status.
Main Results:
- 45% of transplant recipients developed CMV infection; 18.5% had primary infections and 26.5% had reactivation/reinfection.
- Primary CMV infection led to mortality in 6 patients, with severe disease in CMV-seronegative recipients of organs from CMV-seropositive donors.
- Heart and lung transplant recipients had more severe primary CMV infections compared to heart-only recipients.
Conclusions:
- CMV infection is a major concern in heart and lung transplant recipients, with primary infections being particularly dangerous.
- Donor-recipient CMV serological status is critical for predicting disease severity.
- A mu-capture ELISA for CMV-specific IgM is a sensitive and rapid diagnostic tool with prognostic value.
Abstract:
Of the first 166 heart and 15 heart and lung transplant recipients at Papworth Hospital, Cambridge, who survived for more than one month after transplantation, 162 were investigated for cytomegalovirus (CMV) infection by serological methods. Altogether, 73 (45%) developed CMV infection after transplantation: 30 (18.5%) had acquired primary infection and 43 (26.5%) reactivation or reinfection. Six patients died of primary infection, probably acquired from the donor organ. Recipients negative for CMV antibody who received an organ from an antibody positive donor had the most severe disease. Heart and lung transplant recipients experienced more severe primary CMV infection than those in whom the heart alone was transplanted. The most sensitive and rapid serological method was a mu-capture enzyme linked immunosorbent assay (ELISA) for detecting CMV specific IgM, the amount of which was often of prognostic value and influenced the management of patients.