The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Differences of cytomegalovirus diseases between kidney and hematopoietic stem cell transplant recipients during preemptive therapy

  • Kim, Tark (Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Lee, Yu-Mi (Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Sang-Oh (Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Sang-Ho (Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Yang Soo (Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Woo, Jun Hee (Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Sung, Heungsup (Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jung, Joo Hee (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Shin, Sung (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Young Hoon (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kang, Young-Ah (Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Young-Shin (Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Jung-Hee (Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Je-Hwan (Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Kyoo-Hyung (Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Su-Kil (Department of Nephrology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Han, Duck Jong (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Sung-Han (Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2015.03.25
  • Accepted : 2015.06.30
  • Published : 2016.09.01
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Abstract

Background/Aims: Cytomegalovirus (CMV) surveillance and preemptive therapy is a widely-used strategy for preventing CMV disease in transplant recipients. However, there are limited data on the incidence and patterns of CMV disease during the preemptive period. Thus, we investigated the incidence and pattern of tissue-invasive CMV disease in CMV seropositive kidney transplantation (KT) and hematopoietic stem cell transplantation (HCT) recipients during preemptive therapy. Methods: We prospectively identified patients with tissue-invasive CMV disease among 664 KT (90%) and 496 HCT (96%) recipients who were D+/R+ (both donor and recipient seropositive) during a 4-year period. Results: The incidence rates of CMV disease were 4.1/100 person-years (4%, 27/664) in KT recipients and 5.0/100 person-years (4%, 21/496) in HCT recipients. Twenty-six (96%) of the KT recipients with CMV disease had gastrointestinal CMV, whereas 17 (81%) of the HCT recipients had gastrointestinal CMV and 4 (19%) had CMV retinitis. Thus, CMV retinitis was more common among HCT recipients (p = 0.03). All 27 KT recipients with CMV disease suffered abrupt onset of CMV disease before or during preemptive therapy; 10 (48%) of the 21 HCT recipients with CMV disease were also classified in this way but the other 11 (52%) were classified as CMV disease following successful ganciclovir preemptive therapy (p < 0.001). Conclusions: The incidence of CMV disease was about 4% in both KT and HCT recipients during preemptive therapy. However, CMV retinitis and CMV disease as a relapsed infection were more frequently found among HCT recipients.

Keywords

Acknowledgement

Supported by : Korea Health Industry Development Institute (KHIDI)

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