Epidemiology and long-term outcomes of cytomegalovirus DNAemia and disease in pediatric solid organ transplant recipients

Kristen G. Valencia Deray; Kathleen E. Hosek; Divya Chilukuri; Jordan R. Dunson; David R. Spielberg; Sarah J. Swartz; Joseph A. Spinner; Daniel H. Leung; Elizabeth A. Moulton; Flor M. Munoz; Gail J. Demmler-Harrison; Claire E. Bocchini

doi:10.1111/ajt.16822

Epidemiology and long-term outcomes of cytomegalovirus DNAemia and disease in pediatric solid organ transplant recipients

Kristen G. Valencia Deray^*, Kathleen E. Hosek, Divya Chilukuri, Jordan R. Dunson, David R. Spielberg, Sarah J. Swartz, Joseph A. Spinner, Daniel H. Leung, Elizabeth A. Moulton, Flor M. Munoz, Gail J. Demmler-Harrison, Claire E. Bocchini

^*Corresponding author for this work

Pediatrics

Research output: Contribution to journal › Article › peer-review

14 Scopus citations

Abstract

Despite prevention strategies, cytomegalovirus (CMV) remains a common infection in pediatric solid organ transplant recipients (SOTR). We sought to determine the frequency, associations with, and long-term outcomes of CMV DNAemia in pediatric SOTR. We performed a single-center retrospective cohort study, including 687 first time SOTR ≤21 years receiving universal prophylaxis from 2011 to 2018. Overall, 159 (23%) developed CMV DNAemia, the majority occurring after completing primary prophylaxis. CMV disease occurred in 33 (5%) SOTR, 25 (4%) with CMV syndrome and 10 (1%) with proven/probable tissue-invasive disease. CMV contributed to the death of three (0.4%) patients (all lung). High-risk (OR 6.86 [95% CI, 3.6–12.9]) and intermediate-risk (4.36 [2.3–8.2]) CMV status and lung transplantation (4.63 [2.33–9.2]) were associated with DNAemia on multivariable analysis. DNAemia was associated with rejection in liver transplant recipients (p <.01). DNAemia was not associated with an increase in graft failure, all-cause mortality, or other organ-specific poor outcomes. We report one of the lowest rates of CMV disease after SOTR, showing that universal prophylaxis is effective and should be continued. However, we observed CMV morbidity and mortality in a subset of patients, highlighting the need for research on optimal prevention strategies. This study was IRB approved. (Figure presented.).

Original language	English (US)
Pages (from-to)	187-198
Number of pages	12
Journal	American Journal of Transplantation
Volume	22
Issue number	1
DOIs	https://doi.org/10.1111/ajt.16822
State	Published - Jan 2022

Funding

We gratefully acknowledge Dr. Janine Daily-Garnes, Dr. Susan Denfield, and Dr. Debra Palazzi for their participation on Dr. Valencia Deray's Scholarship Oversight Committee and assistance with the study design. We also acknowledge Dr. Sarah Nicholas for her assistance with the interpretation of immunology laboratories, Leanne Petters for her assistance with data collection, and Dr. Ryan Rochat for his assistance in making the study flow diagram.

ASJC Scopus subject areas

Transplantation
Pharmacology (medical)
Immunology and Allergy

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10.1111/ajt.16822

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Valencia Deray, K. G., Hosek, K. E., Chilukuri, D., Dunson, J. R., Spielberg, D. R., Swartz, S. J., Spinner, J. A., Leung, D. H., Moulton, E. A., Munoz, F. M., Demmler-Harrison, G. J., & Bocchini, C. E. (2022). Epidemiology and long-term outcomes of cytomegalovirus DNAemia and disease in pediatric solid organ transplant recipients. American Journal of Transplantation, 22(1), 187-198. https://doi.org/10.1111/ajt.16822

@article{a71f260671b74496834029c999514e3c,

title = "Epidemiology and long-term outcomes of cytomegalovirus DNAemia and disease in pediatric solid organ transplant recipients",

abstract = "Despite prevention strategies, cytomegalovirus (CMV) remains a common infection in pediatric solid organ transplant recipients (SOTR). We sought to determine the frequency, associations with, and long-term outcomes of CMV DNAemia in pediatric SOTR. We performed a single-center retrospective cohort study, including 687 first time SOTR ≤21 years receiving universal prophylaxis from 2011 to 2018. Overall, 159 (23\%) developed CMV DNAemia, the majority occurring after completing primary prophylaxis. CMV disease occurred in 33 (5\%) SOTR, 25 (4\%) with CMV syndrome and 10 (1\%) with proven/probable tissue-invasive disease. CMV contributed to the death of three (0.4\%) patients (all lung). High-risk (OR 6.86 [95\% CI, 3.6–12.9]) and intermediate-risk (4.36 [2.3–8.2]) CMV status and lung transplantation (4.63 [2.33–9.2]) were associated with DNAemia on multivariable analysis. DNAemia was associated with rejection in liver transplant recipients (p <.01). DNAemia was not associated with an increase in graft failure, all-cause mortality, or other organ-specific poor outcomes. We report one of the lowest rates of CMV disease after SOTR, showing that universal prophylaxis is effective and should be continued. However, we observed CMV morbidity and mortality in a subset of patients, highlighting the need for research on optimal prevention strategies. This study was IRB approved. (Figure presented.).",

author = "\{Valencia Deray\}, \{Kristen G.\} and Hosek, \{Kathleen E.\} and Divya Chilukuri and Dunson, \{Jordan R.\} and Spielberg, \{David R.\} and Swartz, \{Sarah J.\} and Spinner, \{Joseph A.\} and Leung, \{Daniel H.\} and Moulton, \{Elizabeth A.\} and Munoz, \{Flor M.\} and Demmler-Harrison, \{Gail J.\} and Bocchini, \{Claire E.\}",

note = "Funding Information: We gratefully acknowledge Dr. Janine Daily-Garnes, Dr. Susan Denfield, and Dr. Debra Palazzi for their participation on Dr. Valencia Deray's Scholarship Oversight Committee and assistance with the study design. We also acknowledge Dr. Sarah Nicholas for her assistance with the interpretation of immunology laboratories, Leanne Petters for her assistance with data collection, and Dr. Ryan Rochat for his assistance in making the study flow diagram. Publisher Copyright: {\textcopyright} 2021 The American Society of Transplantation and the American Society of Transplant Surgeons",

year = "2022",

month = jan,

doi = "10.1111/ajt.16822",

language = "English (US)",

volume = "22",

pages = "187--198",

journal = "American Journal of Transplantation",

issn = "1600-6135",

publisher = "Elsevier B.V.",

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Valencia Deray, KG, Hosek, KE, Chilukuri, D, Dunson, JR, Spielberg, DR, Swartz, SJ, Spinner, JA, Leung, DH, Moulton, EA, Munoz, FM, Demmler-Harrison, GJ & Bocchini, CE 2022, 'Epidemiology and long-term outcomes of cytomegalovirus DNAemia and disease in pediatric solid organ transplant recipients', American Journal of Transplantation, vol. 22, no. 1, pp. 187-198. https://doi.org/10.1111/ajt.16822

TY - JOUR

T1 - Epidemiology and long-term outcomes of cytomegalovirus DNAemia and disease in pediatric solid organ transplant recipients

AU - Valencia Deray, Kristen G.

AU - Hosek, Kathleen E.

AU - Chilukuri, Divya

AU - Dunson, Jordan R.

AU - Spielberg, David R.

AU - Swartz, Sarah J.

AU - Spinner, Joseph A.

AU - Leung, Daniel H.

AU - Moulton, Elizabeth A.

AU - Munoz, Flor M.

AU - Demmler-Harrison, Gail J.

AU - Bocchini, Claire E.

N1 - Funding Information: We gratefully acknowledge Dr. Janine Daily-Garnes, Dr. Susan Denfield, and Dr. Debra Palazzi for their participation on Dr. Valencia Deray's Scholarship Oversight Committee and assistance with the study design. We also acknowledge Dr. Sarah Nicholas for her assistance with the interpretation of immunology laboratories, Leanne Petters for her assistance with data collection, and Dr. Ryan Rochat for his assistance in making the study flow diagram. Publisher Copyright: © 2021 The American Society of Transplantation and the American Society of Transplant Surgeons

PY - 2022/1

Y1 - 2022/1

N2 - Despite prevention strategies, cytomegalovirus (CMV) remains a common infection in pediatric solid organ transplant recipients (SOTR). We sought to determine the frequency, associations with, and long-term outcomes of CMV DNAemia in pediatric SOTR. We performed a single-center retrospective cohort study, including 687 first time SOTR ≤21 years receiving universal prophylaxis from 2011 to 2018. Overall, 159 (23%) developed CMV DNAemia, the majority occurring after completing primary prophylaxis. CMV disease occurred in 33 (5%) SOTR, 25 (4%) with CMV syndrome and 10 (1%) with proven/probable tissue-invasive disease. CMV contributed to the death of three (0.4%) patients (all lung). High-risk (OR 6.86 [95% CI, 3.6–12.9]) and intermediate-risk (4.36 [2.3–8.2]) CMV status and lung transplantation (4.63 [2.33–9.2]) were associated with DNAemia on multivariable analysis. DNAemia was associated with rejection in liver transplant recipients (p <.01). DNAemia was not associated with an increase in graft failure, all-cause mortality, or other organ-specific poor outcomes. We report one of the lowest rates of CMV disease after SOTR, showing that universal prophylaxis is effective and should be continued. However, we observed CMV morbidity and mortality in a subset of patients, highlighting the need for research on optimal prevention strategies. This study was IRB approved. (Figure presented.).

AB - Despite prevention strategies, cytomegalovirus (CMV) remains a common infection in pediatric solid organ transplant recipients (SOTR). We sought to determine the frequency, associations with, and long-term outcomes of CMV DNAemia in pediatric SOTR. We performed a single-center retrospective cohort study, including 687 first time SOTR ≤21 years receiving universal prophylaxis from 2011 to 2018. Overall, 159 (23%) developed CMV DNAemia, the majority occurring after completing primary prophylaxis. CMV disease occurred in 33 (5%) SOTR, 25 (4%) with CMV syndrome and 10 (1%) with proven/probable tissue-invasive disease. CMV contributed to the death of three (0.4%) patients (all lung). High-risk (OR 6.86 [95% CI, 3.6–12.9]) and intermediate-risk (4.36 [2.3–8.2]) CMV status and lung transplantation (4.63 [2.33–9.2]) were associated with DNAemia on multivariable analysis. DNAemia was associated with rejection in liver transplant recipients (p <.01). DNAemia was not associated with an increase in graft failure, all-cause mortality, or other organ-specific poor outcomes. We report one of the lowest rates of CMV disease after SOTR, showing that universal prophylaxis is effective and should be continued. However, we observed CMV morbidity and mortality in a subset of patients, highlighting the need for research on optimal prevention strategies. This study was IRB approved. (Figure presented.).

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DO - 10.1111/ajt.16822

M3 - Article

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AN - SCOPUS:85114692776

SN - 1600-6135

VL - 22

SP - 187

EP - 198

JO - American Journal of Transplantation

JF - American Journal of Transplantation

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ER -

Epidemiology and long-term outcomes of cytomegalovirus DNAemia and disease in pediatric solid organ transplant recipients

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