Clinical Application of Variation in Replication Kinetics During Episodes of Post-transplant Cytomegalovirus Infections

I P Lodding; H Sengeløv; C da Cunha-Bang; M Iversen; Allan Rasmussen; F Gustafsson; John Downing; J Grarup; N Kirkby; Camilla Frederiksen; A Mocroft; S S Sørensen; J D Lundgren; MATCH Programme Study Group

doi:10.1016/j.ebiom.2015.05.003

Clinical Application of Variation in Replication Kinetics During Episodes of Post-transplant Cytomegalovirus Infections

I P Lodding, H Sengeløv, C da Cunha-Bang, M Iversen, Allan Rasmussen, F Gustafsson, John Downing, J Grarup, N Kirkby, Camilla Frederiksen, A Mocroft, S S Sørensen, J D Lundgren, MATCH Programme Study Group

Afdeling for Klinisk Mikrobiologi

23 Citationer (Scopus)

Abstract

BACKGROUND: Cytomegalovirus (CMV) infection in transplant recipients is reported to replicate with a doubling time of 1.2-2 days, and weekly screening is recommended for early diagnosis. We re-evaluated these features in our cohort of transplant recipients.

METHODS: The CMV doubling time of the first CMV infection in the first year post-transplant could be calculated for 193 recipients of haematopoietic stem cell or solid organ transplantation. Factors determining the proportion of recipients with a high diagnostic CMV viral load (≥ 18,200 IU/mL) were explored using mathematical simulation.

FINDINGS: The overall median doubling time was 4.3 days (IQR 2.5-7.8) and was not influenced by prior CMV immunity, or type of transplantation (p > 0.4). Assuming a fixed doubling time of 1.3 days and screening intervals of 7 or 10 days, 11.1% and 33.3% were projected to have a high CMV viral load at diagnosis, compared to 1.4% and 4.3% if the doubling time varies as observed in our cohort. Consistently, 1.9% of recipients screened weekly had a high diagnostic virus load.

INTERPRETATION: Screening intervals can be extended to 10 days in cohorts with comparable CMV doubling time, whereas shorter than 7 days is required in cohorts with shorter doubling times to maintain pre-emptive screening quality.

Originalsprog	Engelsk
Tidsskrift	EBioMedicine
Vol/bind	2
Udgave nummer	7
Sider (fra-til)	699-705
Antal sider	7
DOI	https://doi.org/10.1016/j.ebiom.2015.05.003
Status	Udgivet - jul. 2015

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10.1016/j.ebiom.2015.05.003

Citationsformater

Lodding, I. P., Sengeløv, H., da Cunha-Bang, C., Iversen, M., Rasmussen, A., Gustafsson, F., Downing, J., Grarup, J., Kirkby, N., Frederiksen, C., Mocroft, A., Sørensen, S. S., Lundgren, J. D., & MATCH Programme Study Group (2015). Clinical Application of Variation in Replication Kinetics During Episodes of Post-transplant Cytomegalovirus Infections. EBioMedicine, 2(7), 699-705. https://doi.org/10.1016/j.ebiom.2015.05.003

Lodding, IP, Sengeløv, H , da Cunha-Bang, C, Iversen, M, Rasmussen, A , Gustafsson, F, Downing, J, Grarup, J, Kirkby, N, Frederiksen, C, Mocroft, A, Sørensen, SS , Lundgren, JD & MATCH Programme Study Group 2015, 'Clinical Application of Variation in Replication Kinetics During Episodes of Post-transplant Cytomegalovirus Infections', EBioMedicine, bind 2, nr. 7, s. 699-705. https://doi.org/10.1016/j.ebiom.2015.05.003

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title = "Clinical Application of Variation in Replication Kinetics During Episodes of Post-transplant Cytomegalovirus Infections",

abstract = "BACKGROUND: Cytomegalovirus (CMV) infection in transplant recipients is reported to replicate with a doubling time of 1.2-2 days, and weekly screening is recommended for early diagnosis. We re-evaluated these features in our cohort of transplant recipients.METHODS: The CMV doubling time of the first CMV infection in the first year post-transplant could be calculated for 193 recipients of haematopoietic stem cell or solid organ transplantation. Factors determining the proportion of recipients with a high diagnostic CMV viral load (≥ 18,200 IU/mL) were explored using mathematical simulation.FINDINGS: The overall median doubling time was 4.3 days (IQR 2.5-7.8) and was not influenced by prior CMV immunity, or type of transplantation (p > 0.4). Assuming a fixed doubling time of 1.3 days and screening intervals of 7 or 10 days, 11.1% and 33.3% were projected to have a high CMV viral load at diagnosis, compared to 1.4% and 4.3% if the doubling time varies as observed in our cohort. Consistently, 1.9% of recipients screened weekly had a high diagnostic virus load.INTERPRETATION: Screening intervals can be extended to 10 days in cohorts with comparable CMV doubling time, whereas shorter than 7 days is required in cohorts with shorter doubling times to maintain pre-emptive screening quality.",

author = "Lodding, {I P} and H Sengel{\o}v and {da Cunha-Bang}, C and M Iversen and Allan Rasmussen and F Gustafsson and John Downing and J Grarup and N Kirkby and Camilla Frederiksen and A Mocroft and S{\o}rensen, {S S} and Lundgren, {J D} and {MATCH Programme Study Group}",

year = "2015",

month = jul,

doi = "10.1016/j.ebiom.2015.05.003",

language = "English",

volume = "2",

pages = "699--705",

journal = "EBioMedicine",

issn = "2352-3964",

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TY - JOUR

T1 - Clinical Application of Variation in Replication Kinetics During Episodes of Post-transplant Cytomegalovirus Infections

AU - Lodding, I P

AU - Sengeløv, H

AU - da Cunha-Bang, C

AU - Iversen, M

AU - Rasmussen, Allan

AU - Gustafsson, F

AU - Downing, John

AU - Grarup, J

AU - Kirkby, N

AU - Frederiksen, Camilla

AU - Mocroft, A

AU - Sørensen, S S

AU - Lundgren, J D

AU - MATCH Programme Study Group

PY - 2015/7

Y1 - 2015/7

N2 - BACKGROUND: Cytomegalovirus (CMV) infection in transplant recipients is reported to replicate with a doubling time of 1.2-2 days, and weekly screening is recommended for early diagnosis. We re-evaluated these features in our cohort of transplant recipients.METHODS: The CMV doubling time of the first CMV infection in the first year post-transplant could be calculated for 193 recipients of haematopoietic stem cell or solid organ transplantation. Factors determining the proportion of recipients with a high diagnostic CMV viral load (≥ 18,200 IU/mL) were explored using mathematical simulation.FINDINGS: The overall median doubling time was 4.3 days (IQR 2.5-7.8) and was not influenced by prior CMV immunity, or type of transplantation (p > 0.4). Assuming a fixed doubling time of 1.3 days and screening intervals of 7 or 10 days, 11.1% and 33.3% were projected to have a high CMV viral load at diagnosis, compared to 1.4% and 4.3% if the doubling time varies as observed in our cohort. Consistently, 1.9% of recipients screened weekly had a high diagnostic virus load.INTERPRETATION: Screening intervals can be extended to 10 days in cohorts with comparable CMV doubling time, whereas shorter than 7 days is required in cohorts with shorter doubling times to maintain pre-emptive screening quality.

AB - BACKGROUND: Cytomegalovirus (CMV) infection in transplant recipients is reported to replicate with a doubling time of 1.2-2 days, and weekly screening is recommended for early diagnosis. We re-evaluated these features in our cohort of transplant recipients.METHODS: The CMV doubling time of the first CMV infection in the first year post-transplant could be calculated for 193 recipients of haematopoietic stem cell or solid organ transplantation. Factors determining the proportion of recipients with a high diagnostic CMV viral load (≥ 18,200 IU/mL) were explored using mathematical simulation.FINDINGS: The overall median doubling time was 4.3 days (IQR 2.5-7.8) and was not influenced by prior CMV immunity, or type of transplantation (p > 0.4). Assuming a fixed doubling time of 1.3 days and screening intervals of 7 or 10 days, 11.1% and 33.3% were projected to have a high CMV viral load at diagnosis, compared to 1.4% and 4.3% if the doubling time varies as observed in our cohort. Consistently, 1.9% of recipients screened weekly had a high diagnostic virus load.INTERPRETATION: Screening intervals can be extended to 10 days in cohorts with comparable CMV doubling time, whereas shorter than 7 days is required in cohorts with shorter doubling times to maintain pre-emptive screening quality.

U2 - 10.1016/j.ebiom.2015.05.003

DO - 10.1016/j.ebiom.2015.05.003

M3 - Journal article

C2 - 26288842

SN - 2352-3964

VL - 2

SP - 699

EP - 705

JO - EBioMedicine

JF - EBioMedicine

IS - 7

ER -

Clinical Application of Variation in Replication Kinetics During Episodes of Post-transplant Cytomegalovirus Infections

Abstract

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