Donor Cytomegalovirus Transmission Patterns in Solid Organ Transplant Recipients With Primary Infection

Background. The epidemiology of single versus multiple cytomegalovirus (CMV) strain transmission from donor (D+) to seronegative solid organ transplant (SOT) recipients (R-) is uncertain, as is whether relapsing recipient infection represents changing strain predominance when multiple strains are transmitted. Here we characterized CMV strain transmission patterns in D+/R- SOT recipients. Methods. We studied pairs or groups of D+/R- SOT recipients who received organs from a common donor (group A) and recipients who experienced >= 2 waves of CMV DNAemia (group B). CMV in plasma was characterized by genotype-specific real-time PCR for genes gB and gH. Results. Single concordant genotypes were identified in 12 of 18 recipient pairs/group sharing a common donor (group A); at least 6 of 18 (33%) donors transmitted > 1 strain. A single CMV strain was detected in 14 of 15 recipients in group B; only 1 recipient had coinfection. A shift in CMV strain predominance occurred after the first posttransplant year in at least 4 recipients with coinfection. Conclusions. Using a common donor approach, we confirmed that multiple CMV strain transmission from donors to R- SOT recipients is not uncommon. D+/R- SOT recipients with CMV coinfection can undergo changes in strain predominance in late waves of CMV DNAemia.

Automated summary

The study found that multiple CMV strain transmission from donors to seronegative solid organ transplant (SOT) recipients is not uncommon, with multiple strains identified in some recipients. Therefore, D+/R- SOT recipients with CMV coinfection can experience changes in strain predominance in late waves of CMV DNAemia.