Evaluation of cytomegalovirus Blips in high-risk kidney/kidney-pancreas transplant recipients

Background Cytomegalovirus (CMV) is a significant cause of morbidity and mortality after solid organ transplantation. While guidelines suggest using highly sensitive QNAT assays for CMV detection, there is no defined viral load to guide initiation of preemptive therapy. This study evaluates the progression to quantifiable CMV (DNAemia) following a CMV blip in high-risk (D+/R) kidney/kidney-pancreas (KP) transplant recipients. Methods This is a single center, retrospective study. A CMV blip was defined as the first positive QNAT assay below the level of quantification (<1.37 x 10(2) IU/ml or <200 viral copies). Subsequent CMV QNAT assays were followed to assess the progression from blip to CMV DNAemia for 1 year following transplant. Results A total of 134 patients were included in the study. Fifty-three (39.6%) patients had their first positive CMV QNAT value below the level of quantification, a CMV blip. Of these 53 patients, 69.8% (n = 37) progressed to DNAemia while 30.2% (n = 16) did not. The median time from transplant to the first CMV blip was 68 (46-97) days and most patients with viral blips (71.1%) were on prophylaxis. No differences in patient characteristics were found among those who progressed from blip to DNAemia and those who only had a blip. Conclusions In CMV high-risk kidney/KP transplant recipients, CMV blips progressed to CMV DNAemia in the majority of cases. This progression typically occurred 2-3 weeks following the initial blip. CMV blips are common early posttransplant despite prophylaxis and likely represent an early marker of CMV infection.

Automated summary

In high-risk kidney/kidney-pancreas transplant recipients, CMV blips often progress to CMV DNAemia. This progression typically occurs 2-3 weeks after the initial blip. Despite prophylaxis, CMV blips are common early posttransplant and likely represent an early marker of CMV infection.