Refractory, Resistant and Recurrent Cytomegalovirus Infections in Solid Organ Transplant Recipients: Risk Factors and...

Area of Science:

• Transplant Infectious Diseases
• Virology
• Immunology

Background:

• Cytomegalovirus (CMV) infection is a major post-transplant complication.
• Managing refractory and resistant CMV infections in solid organ transplant (SOT) recipients is challenging.

Purpose of the Study:

• To investigate risk factors for refractory, resistant, and recurrent CMV infections in SOT recipients.
• To analyze outcomes including mortality associated with CMV infection.

Main Methods:

• Retrospective multicenter cohort study of 145 SOT recipients with clinically significant CMV infection (csCMVi) from 2010-2016.
• Analysis included Kaplan-Meier, univariable logistic regression, and multivariable Cox regression to assess outcomes like early refractory CMV, drug resistance, recurrence, and mortality.

Main Results:

• Refractory CMV infection occurred in 8.9% of patients, associated with CMV D+/R- mismatch, earlier onset, and lower absolute lymphocyte count (ALC).
• Drug-resistant CMV occurred in 4.8%, linked to high initial CMV DNA levels. Recurrence affected 17.2% within 6 months.
• While refractory, resistant, or recurrent CMV infections were not directly linked to mortality, low ALC at treatment end suggested potential recurrence.

Conclusions:

• Refractory CMV infection post-SOT is associated with specific donor/recipient mismatches, earlier post-transplant timing, and lower ALC.
• High initial CMV DNA levels are a predictor of drug-resistant CMV infection.
• Recurrence of CMV infection is frequent and may be influenced by low ALC post-treatment.