Efficacy of Valganciclovir Administered as Preemptive Therapy for Cytomegalovirus Disease in Liver Transplant Recipients: Impact on Viral Load and Late-Onset Cytomegalovirus Disease

2005 ◽  
Vol 79 (1) ◽  
pp. 85-90 ◽  
Author(s):  
Nina Singh ◽  
Cheryl Wannstedt ◽  
Lois Keyes ◽  
Timothy Gayowski ◽  
Marilyn M. Wagener ◽  
...  
Keyword(s):  
Viral Load ◽  
Liver Transplant ◽  
Late Onset ◽  
Preemptive Therapy ◽  
Transplant Recipients ◽  
Cytomegalovirus Disease ◽  
Liver Transplant Recipients

Unexpected CMV replication kinetics in CMV- donor seropositive recipient seronegative liver transplant recipients receiving preemptive antiviral therapy

2021 ◽  
Author(s):  
Nina Singh ◽  
Drew J Winston ◽  
Raymund R Razonable ◽  
G Marshall Lyon ◽  
Fernanda P Silveira ◽  
...  
Keyword(s):  
Viral Load ◽  
Liver Transplant ◽  
Preemptive Therapy ◽  
Transplant Recipients ◽  
Viral Loads ◽  
Level Increase ◽  
Study Population ◽  
Cmv Resistance ◽  
High Level ◽  
Liver Transplant Recipients

Abstract Background Detailed CMV kinetics in donor CMV-seropositive, recipient CMV-seronegative (D+R-) transplant recipients receiving preemptive therapy (PET) have not been fully defined. Methods The study population consisted of PET arm of a randomized CMV prevention trial in D+R- liver transplant recipients. CMV-DNA PCR assays were performed weekly for 100 days using a sensitive assay. Viral load and clinical parameters were compared for patients with or without high-level increase (defined as higher than the group median log10 increase in viral load from baseline after PET initiation). Results Among 79 patients, 93.6% (74/79) developed an increase from baseline viral loads of median 120 IU/mL to 3,350 IU/mL; 25.7% (19/74) of the patients had peak levels > 10,000 IU/mL. None of the patients with rise in viral load underwent testing for CMV resistance and viremia resolved with PET with valganciclovir. Patients with high-level increase in viral load had significantly lower rate of recurrent viremia than those without such increase (40%,16/40 vs. 71.8%, 28/39, p=0.004), respectively. Conclusions A majority of D+R- recipients had a marked increase in viral load after initiation of PET before resolution of viremia. This phenomenon is associated with lower rates of subsequent recurrent viremia and does not necessarily imply antiviral resistance.

scholarly journals Prophylaxis versus preemptive therapy for cytomegalovirus disease in high-risk liver transplant recipients

2012 ◽  
Vol 18 (9) ◽  
pp. 1093-1099 ◽  
Author(s):  
Marta Bodro ◽  
Núria Sabé ◽  
Laura Lladó ◽  
Carme Baliellas ◽  
Jordi Niubó ◽  
...  
Keyword(s):  
High Risk ◽  
Liver Transplant ◽  
Preemptive Therapy ◽  
Transplant Recipients ◽  
Cytomegalovirus Disease ◽  
Liver Transplant Recipients

Late-Onset Cytomegalovirus Disease in Liver Transplant Recipients Despite Antiviral Prophylaxis1

2004 ◽  
Vol 78 (9) ◽  
pp. 1390-1396 ◽  
Author(s):  
Ajit P. Limaye ◽  
Ramaswamy Bakthavatsalam ◽  
Hyung W. Kim ◽  
Christian S. Kuhr ◽  
Jeffrey B. Halldorson ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Late Onset ◽  
Transplant Recipients ◽  
Cytomegalovirus Disease ◽  
Liver Transplant Recipients

scholarly journals Prospective Assessment of Cytomegalovirus Immunity in High-Risk Donor-Seropositive/Recipient-Seronegative Liver Transplant Recipients Receiving Either Preemptive Therapy or Antiviral Prophylaxis

2019 ◽  
Vol 220 (5) ◽  
pp. 752-760 ◽  
Author(s):  
Ajit P Limaye ◽  
Margaret L Green ◽  
Bradley C Edmison ◽  
Terry Stevens-Ayers ◽  
Sam Chatterton-Kirchmeier ◽  
...  
Keyword(s):  
T Cell ◽  
High Risk ◽  
Liver Transplant ◽  
Late Onset ◽  
T Cell Responses ◽  
Preemptive Therapy ◽  
Antiviral Prophylaxis ◽  
Transplant Recipients ◽  
Cell Responses ◽  
Liver Transplant Recipients

Abstract The differential impact of preemptive therapy (PET) and antiviral prophylaxis (AP) on development of cytomegalovirus (CMV)–specific neutralizing antibody (nAb) and T-cell responses have not previously been directly compared in high-risk donor-seropositive/recipient-seronegative (D+R−) organ transplant recipients. We prospectively assessed T-cell and nAb responses 3 months after transplantation in cohorts of high-risk D+R− liver transplant recipients who received either PET (n = 15) or AP (n = 25) and a control group of CMV-seropositive transplant recipients (R+) (AP; n = 24). CMV phosphoprotein 65 (pp65)– and immediate early protein 1–specific multifunctional T-cell responses were determined by means of intracellular cytokine staining and nAbs against BADrUL131-Y4 CMV in adult retinal pigment epithelial cell line-19 human epithelial cells; nAbs were detected in 8 of 12 (67%) in the PET group, none of 17 in the AP group, and 20 of 22 (91%) in the R+ group. Multifunctional CD8 and CD4 T-cell responses to pp65 were generally similar between PET and R+ groups, and lower for the AP group; multifunctional CD4 responses were similar across all groups. Among D+R− liver transplant recipients, PET was associated with the development of greater nAb and multifunctional CD8 T-cell responses compared with AP, providing a potential mechanism to explain the relative protection against late-onset disease with PET. Future studies are needed to define specific immune parameters predictive of late-onset CMV disease with AP.

scholarly journals Effect of Preemptive Therapy vs Antiviral Prophylaxis on Cytomegalovirus Disease in Seronegative Liver Transplant Recipients With Seropositive Donors

JAMA ◽  
2020 ◽  
Vol 323 (14) ◽  
pp. 1378 ◽  
Author(s):  
Nina Singh ◽  
Drew J. Winston ◽  
Raymund R. Razonable ◽  
G. Marshall Lyon ◽  
Fernanda P. Silveira ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Preemptive Therapy ◽  
Antiviral Prophylaxis ◽  
Transplant Recipients ◽  
Cytomegalovirus Disease ◽  
Liver Transplant Recipients
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