Abstract
This retrospective multicenter cohort study investigated the kinetics (ascending and descending phases) of cytomegalovirus (CMV) and Epstein-Barr virus (EBV)-DNA in whole blood (WB) and plasma samples collected from adult kidney transplant (KT) recipients. CMV-DNA kinetics according to antiviral therapy were investigated. Three hundred twenty-eight paired samples from 42 episodes of CMV infection and 157 paired samples from 26 episodes of EBV infection were analyzed by a single commercial molecular method approved by regulatory agencies for both matrices. CMV-DNAemia followed different kinetics in WB and plasma. In the descending phase of infection, a slower decay of viral load and a higher percentage of CMV-DNA positive samples were observed in plasma versus WB. In the 72.4% of patients receiving antiviral therapy, monitoring with plasma CMV-DNAemia versus WB CMV-DNAemia could delay treatment interruption by 7–14 days. Discontinuation of therapy based on WB monitoring did not result in relapsed infection in any patients. Highly different EBV-DNA kinetics in WB and plasma were observed due to lower positivity in plasma; EBV positive samples with a quantitative result in both blood compartments were observed in only 11.5% of cases. Our results emphasize the potential role of WB as specimen type for post-KT surveillance of both infections for disease prevention and management.
Highlights
Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) have a central role in kidney transplant recipients (KTRs) [1]
We investigated the kinetics of both viruses in whole blood (WB) and plasma samples collected from adult KTRs
The total number of paired samples investigated for the search of CMV and EBV-DNA was 328 and 157, respectively; the median number of sequential paired samples tested per infection episode was 7
Summary
Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) have a central role in kidney transplant recipients (KTRs) [1]. In solid organ transplant (SOT), kinetics analyses have never been performed of CMV and EBV-DNAemia in WB and plasma using a single, approved molecular method for quantifying CMV and EBV-DNA in both blood matrices. In a previous study [6], we investigated the kinetics of both CMV and EBV-DNAemia in WB and plasma collected from pediatric and adult allogeneic hematopoietic stem cell transplant (HSCT) recipients using a CE-marked and FDA-approved automated molecular method. These data demonstrated that CMV and EBV-DNAemia follow different kinetics in the two blood compartments in HSCT [6]. These observations may impact monitoring, prophylactic and therapeutic management strategies for these infections
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