2292. Cytomegalovirus DNA in Transplant Recipients: Comparison of Whole Blood and Plasma Viral Loads
Session: Poster Abstract Session: Transplants: CMV and Transplantation
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • ID Week poster 2016-10-24.pdf (324.1 kB)
  • Background:  Cytomegalovirus (CMV) infection is a major cause of morbidity after solid organ (SOT) or stem cell transplantation (SCT). Currently, quantitative CMV DNA testing (QNAT) is the primary method for diagnosis and guiding treatment. There continues to be a debate on whether whole blood (WB) or plasma is the ideal sample for QNAT. Previous studies using laboratory-developed assays showed higher sensitivity with WB. However, the validity of this finding remains unknown in this era of highly sensitive QNAT calibrated to the WHO International standard.

    Methods:  We conducted a single-center prospective study of SOT and SCT recipients with CMV disease to collect weekly paired plasma and WB samples. All samples were tested with the COBAS® AmpliPrep/COBAS® TaqMan® CMV Test (Roche Molecular Systems, Inc., Branchburg, NJ) with modification of the assay for testing WB.

    Results:  A total of 88 patients were enrolled: 58 (61%) male subject; median age of 56.7 (range, 47.8 - 63.0) years; 46 (52%) SOT and 42 (48%) SCT recipients. Of the SOT recipients, 24 (52%) had asymptomatic viremia and 22 (48%) with disease. In the SCT group, 33 (79%) had asymptomatic viremia, and 9 (21%) with disease. Overall, there was modest agreement in qualitative results between plasma and WB viral load (VL) based on a total of 403 paired samples (total agreement=69.2%; kappa=0.49 [95% CI; 0.43, 0.56]). Among pairs in which the VL was quantifiable, correlation between plasma and WB VL was modest (r=0.699), with VL from WB higher than those from plasma by a consistent margin (Figure). Initial and peak VL (expressed as median with first and third quartile values) in both plasma and WB were significantly different between asymptomatic and symptomatic disease (Table).  

    Conclusion:  The correlation between plasma and WB was modest, with higher VL observed in WB. Regardless of specimen type, higher VL was associated with symptomatic CMV disease.

     

    CMV VL  

    N

    Symptomatic (n=31)

    Asymptomatic (n=57)

    P valuea

    Initial VL, plasma

    83

    4,880 (1,570, 20,800)

    470 (290, 1,140)

    <0.001

    Peak VL, plasma

    88

    5,450 (1,570, 20,800)

    825 (363, 2,030)

    <0.001

    Initial VL, whole blood

    83

    14,846 (1,988, 85,378)

    5,004 (1,045, 8,247)

    0.005

    Peak VL, whole blood

    88

    27,641 (2,897, 100,091)

    5,349 (1,631, 11,613)

    0.002

     

     

     

     

     

    a Kruskal-Wallis rank sum test

    Maria Dioverti, M.D.1, Brian Lahr, MS2, Jeffrey Germer, BS3, Joseph Yao, MD, FIDSA1 and Raymund R. Razonable, MD, FIDSA4, (1)Mayo Clinic, Rochester, MN, (2)Biomedical Statistics and Informatics, Mayo Clinic, College of Medicine, Rochester, MN, (3)Mayo Clinic, Rochester, CA, (4)Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN

    Disclosures:

    M. Dioverti, None

    B. Lahr, None

    J. Germer, None

    J. Yao, None

    R. R. Razonable, None

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