401. Occurrence of CMV Viremia in Patients More than 1 Year Post-Solid Organ Transplantation
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: CMV typically occurs during the first year following solid organ transplant (tx), after cessation of prophylaxis, rarely occurring later. CMV occurring after the first post-tx year is not well described. We therefore compared the occurrence, potential associations, and outcomes in patients with CMV after the first post-transplant year (LATE) to those developing CMV earlier (EARLY).
Methods: All patients with CMV between January 2006 and October 2008 at a single large tx center were identified. Pts with antigenemia > 10 nuclei/200,000 leukocytes or DNA > 500 copies/ml meeting at least one of the following clinical criteria for active infection were included: symptomatic, required treatment, and/or biopsy proven disease. Demographics, donor and recipient CMV serostatus, immunosuppression, rejection, comorbidities, prior CMV infection, symptoms, treatment, and outcomes were collected.
Results:
$$table_?$$
Table: Characteristics of CMV Cases
LATE (n=23)EARLY (n=62)
Male18 (78%)43 (69%)
Organ tx:
Heart
Lung
Liver
Kidney
Multiorgan
11
6
1
5
0
14
13
12
16
7
Median peak DNA (copies/ml)31,609 (IQR 3,062-152,434)23,086 (IQR 6,728-127,152)
Median peak AG (nuclei/200,000 leukocytes)80 (IQR 19-282)100* (IQR 48- > 100)
Median onset (mos)56 (IQR 16.5-105)5.5 (IQR 4-7)
CMV serostatus

D+R- 9
D+R+ 5
D-R+ 3
D-R- 3

Unk 3

D+R- 46
D+R+ 9
D-R+ 5
D-R- 2
End organ manifestation:
Gastrointestinal
Pneumonia
Pancytopenia
Disseminated
Other
12 (52%)
9
1
1
1
0
18 (29%)
11
5
0
1
2
Treatment
Antiviral
Decreased immunosuppression
21
18
61
54
Mortality within 1 mo42

Table 1 summarizes characteristics of EARLY vs. LATE. 3/23 LATE had prior CMV viremia in the first year. At diagnosis, 7 EARLY and 0 LATE were on valganciclovir/ganciclovir prophylaxis (p=NS). 29 EARLY and 10 LATE had a rejection episode in the last 6 mos and 20 EARLY and 3 LATE had Anti-lymphocyte antibody induction within the last 6 mos (p=0.10). Diabetes was significantly associated with EARLY [adjusted OR 0.25 (95% CI 0.08-0.74); p= 0.013] and heart transplant significantly associated with LATE [adjusted OR 4.42 (95% CI 1.43-13.63; p=0.01]. 18 LATE and 61 EARLY cleared viremia. Early mortality was more common in LATE CMV (p=0.04); and not usually attributable to CMV.
Conclusion: CMV viremia continues to occur after the first year post-solid organ transplant and can be associated with poor outcomes. Heart transplant patients are at significantly higher risk for LATE. Further study is needed to better characterize at risk populations.
Todd Barton, MD1, Emily Blumberg, MD, FIDSA2, Dana Blyth, MD1, Wendi Dull, *1, Leanne Gasink, MD3, Ingi Lee, MD, MSCE1, Patrice Pfeiffenberger, CRNP1, Karen Sims, MD, PhD1, Vivianna Van Deerlin, MD1 and  D. Blyth, None..
I. Lee, None..
K. Sims, None..
L. Gasink, None..
T. Barton, None..
V. Van Deerlin, None..
P. Pfeiffenberger, None..
W. Dull, None. 
E. Blumberg,
Roche Role(s): Consultant, Investigator, Research Relationship, Consultant, Investigator, Research Relationship, Received: Research Support, Consulting Fee.
viropharma Role(s): Investigator, Investigator, Received: Research Support., (1)University of Pennsylvania, Philadelphia, PA, (2)University of Pennsylvania Health System, Philadelphia, PA, (3)Hospital of the University of Pennsylvania, Philadelphia, PA

Disclosures:

T. Barton, None

E. Blumberg, None

D. Blyth, None

W. Dull, None

L. Gasink, None

I. Lee, None

P. Pfeiffenberger, None

K. Sims, None

V. Van Deerlin, None