Importance of the cytomegalovirus seropositive recipient as a contributor to disease burden after solid organ transplantation

Background: The incidence of cytomegalovirus (CMV) syndrome/disease after adult solid organ transplantation in the era effective antiviral therapy has not been fully assessed. Objective: To determines the incidence of CMV syndrome/disease after solid organ transplantation in the UK. Study design: A retrospective analysis of 1807 solid organ transplants from 12 UK solid organ transplant centres representing 32.7% of all transplant activity occurring in the UK between 1/04/2004 and 31/03/2006. Patients were categorised into those experiencing an episode of symptomatic CMV infection after transplant or those who remained free of symptoms. All patients were followed up for 2 years for the occurrence of CMV syndrome/disease. Results: The majority of the transplant centres used valganciclovir prophylaxis in the high risk D+R- patients (91.6%) whereas management of the lower risk D+R+ and D-R+ patients was more variable with deployment of both prophylactic and pre-emptive strategies in similar to 50% of centres. CMV syndrome/disease occurred in 20.5% of the D+R- patients representing 55 cases whereas the incidence was only 8.1% and 9% in the D+R+ and D-R+ group, respectively (p < 0.001 compared to the D+R- group), but representing a further 58 cases of CMV syndrome/disease. CMV viraemia in the D+R- group was associated with a high probability (65%) of CMV syndrome/disease in renal transplant recipients whereas this was less apparent in the intermediate risk groups. Conclusions: CMV syndrome/disease remains an important healthcare burden after solid organ transplantation with the intermediate risk groups contributing similar numbers of cases as the high risk group. (C) 2012 Elsevier B.V. All rights reserved.