1566. Is primary CMV infection post-transplant influenced by circadian rhythms?
Session: Poster Abstract Session: Viruses and Bacteria in Immunocompromised Patients
Friday, October 5, 2018
Room: S Poster Hall
Posters
  • idweek poster 3-converted.pdf (228.7 kB)
  • Background:

    Cytomegalovirus (CMV) infection causes significant morbidity after transplant. Patients can be stratified by donor and recipient CMV serostatus, but the infection phenotype remains variable. We hypothesized that some of this variability might be explained by circadian rhythms influenced by time of transplant.

    Methods:

    Virological, demographic and transplant data were reviewed for liver and kidney transplant patients (n=1111) managed between 2002-2015 using pre-emptive therapy. Donor circulatory arrest time and reperfusion time in the recipient were split into 4 categories, chosen a priori. Patients were categorised into 3 groups depending on donor and recipient CMV serostatus. Differences between groups were assessed using Chi-squared and Kruskall-Wallis tests.

    Results:

    For the donor seropositive/recipient seronegative group (D+R-) all CMV parameters were highest when reperfusion occurred in the day or evening, and the lowest in the night or morning (see table).

    Day

    10am-4pm

    N=101

    Evening

    4pm-10pm

    N=53

    Night

    10pm-4am

    N=30

    Morning

    4am-10am

    N=20

    P value

    Developed CMV Viraemia within 90 days

    % (n)

    Yes

    76.2 (77)

    73.6 (39)

    66.7 (20)

    45.0 (9)

    0.039

    No

    23.8 (24)

    26.4 (14)

    33.3 (10)

    55.0 (11)

    Received anti-CMV Treatment

    % (n)

    Yes

    63.4 (64)

    64.2 (34)

    50.0 (15)

    45.0 (9)

    0.264

    No

    36.6 (37)

    35.9 (19)

    50.0 (15)

    55.0 (11)

    Among those that became viraemic

    Peak viral load,

    Copies/ml

    Median (IQR)

    14870 (3220-97551)

    23789 (3509-58314)

    5685.5 (2711-26407)

    6238 (2839-8131)

    0.074

    Duration viraemia, Days

    Median (IQR)

    42 (24-63)

    42 (18-70)

    31 (21-57)

    34 (26-35)

    0.555

    Duration treatment, Days

    Median (IQR)

    48 (33-64)

    47.5 (29-67)

    42 (29-66)

    28 (21-41)

    0.257

    No such pattern was seen for circulatory arrest time, or in the D-R+ or D+R+ groups.

    Conclusion:

    Time of day of transplant surgery appears to be associated with development of CMV viraemia and the parameters of infection in one subgroup of transplant patients. These differences could be explained by circadian rhythms of CMV replication and/or immunological parameters varying throughout the day. These data therefore provide support for further study of circadian effects on CMV replication and host CMV immunity.

    Hannah Rafferty, BA (Hons), BMBCh1, Jerry Tam, MB BChir PhD1, Colette Smith, PhD2, Matthew Reeves, PhD1, Jane McKeating, PhD3, Dinesh Sharma, MBBS, MS, FRCSEd, FRCS (GENSURG)4, David Whitmore, PhD4 and Paul Griffiths, MD, DSc1, (1)Centre for Virology, University College London, London, United Kingdom, (2)Institute for Global Health, University College London, London, United Kingdom, (3)University of Oxford, Oxford, United Kingdom, (4)University College London, London, United Kingdom

    Disclosures:

    H. Rafferty, None

    J. Tam, None

    C. Smith, None

    M. Reeves, None

    J. McKeating, None

    D. Sharma, None

    D. Whitmore, None

    P. Griffiths, shire: Scientific Advisor , funds paid to my institution not to me . chimerix: Scientific Advisor , funds paid to my institution not to me . sanofi pasteur: Grant Investigator , funds paid to my institution not to me . genentech: Scientific Advisor , funds paid to my institution not to me .

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