دورية أكاديمية
Impact of an ultrasensitive Cytomegalovirus quantitative nucleic acid test on Cytomegalovirus detection and therapy in renal transplant recipients.
| العنوان: | Impact of an ultrasensitive Cytomegalovirus quantitative nucleic acid test on Cytomegalovirus detection and therapy in renal transplant recipients. |
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| المؤلفون: | Beechar VB; Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA., Pouch SM; Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA., Phadke VK; Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA., Karadkhele G; Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA., Larsen CP; Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA., Woodworth MH; Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA. |
| المصدر: | Transplant infectious disease : an official journal of the Transplantation Society [Transpl Infect Dis] 2024 Feb; Vol. 26 (1), pp. e14219. Date of Electronic Publication: 2023 Dec 30. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Munksgaard Country of Publication: Denmark NLM ID: 100883688 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1399-3062 (Electronic) Linking ISSN: 13982273 NLM ISO Abbreviation: Transpl Infect Dis Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Copenhagen : Munksgaard, c1999- |
| مواضيع طبية MeSH: | Kidney Transplantation*/adverse effects , Cytomegalovirus Infections*/diagnosis , Cytomegalovirus Infections*/drug therapy, Humans ; Cytomegalovirus/genetics ; Cohort Studies ; Retrospective Studies ; Transplant Recipients ; DNA, Viral ; Antiviral Agents/therapeutic use |
| مستخلص: | Background: Cytomegalovirus (CMV) infection has broad implications for morbidity and mortality in renal transplant recipients (RTR). Routine surveillance for CMV replication with PCR-based quantitative nucleic acid testing (qNAT) assays is standard practice in most transplant centers, but the impact of assay sensitivity on antiviral decision-making and virologic outcomes has not been studied. We investigated the effects of an ultrasensitive CMV qNAT assay on multiple clinical outcomes, including time to detection and duration of CMV DNAemia. Methods: We conducted a single-center cohort study contrasting RTRs monitored with a qNAT with a higher lower limit of quantification (LLOQ >300 IU/mL) with those monitored with a more sensitive qNAT (LLOQ >35 IU/mL). Patients were stratified by donor (D)/recipient (R) CMV serostatus (D+/R-: high risk; any R+: moderate risk). CMV viral load monitoring was performed monthly post transplantation, with the primary outcomes being time to CMV DNAemia and its duration. Results: Total 1382 patients were analyzed from 2014 to 2016 and 2019 to 2021. Moderate-risk RTRs monitored with the more sensitive assay experienced a greater hazard for the development of a first episode of CMV DNAemia (aHR: 1.95, 95% confidence interval [CI]: 1.55-2.46) and an average of 24 (95% CI: 16.40-31.98) additional days of DNAemia. There was no difference in CMV end-organ disease or 1-year all-cause mortality between moderate-risk RTRs. Conclusions: The more sensitive assay was associated with earlier detection and extended durations of CMV DNAemia in moderate-risk RTRs, without altering clinical outcomes. These findings inform optimal use of these assays and antiviral stewardship in RTRs. Key Summary: The use of ultrasensitive CMV qNAT assays in moderate-risk CMV renal transplant recipients is associated with earlier detection and longer durations of CMV DNAemia without impacting CMV end-organ disease or 1-year mortality. (© 2023 Wiley Periodicals LLC.) |
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| معلومات مُعتمدة: | K23 AI144036 United States AI NIAID NIH HHS; UL1 TR002378 United States TR NCATS NIH HHS; UL1TR002378 United States NH NIH HHS; TL1 TR002382 United States TR NCATS NIH HHS; TL1TR002382 United States NH NIH HHS |
| فهرسة مساهمة: | Keywords: CMV; low level DNAemia; renal transplant recipients |
| المشرفين على المادة: | 0 (DNA, Viral) 0 (Antiviral Agents) |
| تواريخ الأحداث: | Date Created: 20231230 Date Completed: 20240216 Latest Revision: 20240309 |
| رمز التحديث: | 20240309 |
| مُعرف محوري في PubMed: | PMC10922631 |
| DOI: | 10.1111/tid.14219 |
| PMID: | 38158932 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1399-3062 |
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| DOI: | 10.1111/tid.14219 |