Contemporary Cytomegalovirus (CMV) Infections in Low-Risk CMV Seronegative Recipients of Solid Organ Transplants From CMV Seronegative Donors (D-/R-): Time to Reexamine Donor CMV Serostatus

Madeleine R Heldman; Julia A Messina; Annette J Schlueter; Mark J Lee; Jennifer L Saullo; Rachel A Miller

doi:10.1111/ctr.70073

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Contemporary Cytomegalovirus (CMV) Infections in Low-Risk CMV Seronegative Recipients of Solid Organ Transplants From CMV Seronegative Donors (D-/R-): Time to Reexamine Donor CMV Serostatus

Journal article

Peer reviewed

Contemporary Cytomegalovirus (CMV) Infections in Low-Risk CMV Seronegative Recipients of Solid Organ Transplants From CMV Seronegative Donors (D-/R-): Time to Reexamine Donor CMV Serostatus

Madeleine R Heldman, Julia A Messina, Annette J Schlueter, Mark J Lee, Jennifer L Saullo and Rachel A Miller

Clinical transplantation, Vol.39(1), e70073

01/2025

DOI: 10.1111/ctr.70073

PMID: 39737614

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Abstract

Early posttransplant cytomegalovirus (CMV) infections in CMV seronegative solid organ transplant recipients (SOTR) with CMV seronegative donors (D-/R-) are often attributed transfusion-transmitted CMV. The prevalence of false-negative donor CMV serology in D-/R- SOTR with early CMV infections has not been explored. We determined the frequency and characteristics of CMV DNAemia that occurred within 90 days of transplant among adult SOTR classified as D-/R- who underwent a first SOT at a single center between February 25, 2014 and February 25, 2024. Repeat donor CMV antibody testing was performed on stored donor sera if possible. Thirteen of 737 (1.8%) D-/R- SOTR from 12 donors developed CMV DNAemia within 90 days of transplant (median time to DNAemia: 28 days, interquartile range 23-42 days). Five (38%) recipients experienced CMV disease either before (n = 2) or after (n = 3) CMV DNAemia was identified, and five (38%) developed CMV antiviral resistance mutations during their course. Repeat CMV antibody testing was performed on sera from four donors to five recipients and was positive in three (75%) tested donors. Early CMV infections in D-/R- SOTR are uncommon but associated with high morbidity. CMV transmission from organ donors with false negative CMV serology is an important source of early CMV infections in D-/R- SOTR. Clinicians should suspect and promptly report early CMV infections in D-/R- SOTR as potential donor-derived processes, regardless of donor and/or recipient transfusion histories. Reporting such cases is essential to promote broader investigations that may identify suboptimal donor CMV screening assays.

Adult

Antibodies, Viral - blood

Cytomegalovirus - immunology

Cytomegalovirus - isolation & purification

Cytomegalovirus Infections - diagnosis

Cytomegalovirus Infections - epidemiology

Cytomegalovirus Infections - immunology

Cytomegalovirus Infections - virology

DNA, Viral - blood

DNA, Viral - genetics

Female

Follow-Up Studies

Graft Survival

Humans

Male

Middle Aged

Organ Transplantation - adverse effects

Postoperative Complications - diagnosis

Prognosis

Retrospective Studies

Risk Factors

Tissue Donors

Transplant Recipients

Details

Title: Subtitle: Contemporary Cytomegalovirus (CMV) Infections in Low-Risk CMV Seronegative Recipients of Solid Organ Transplants From CMV Seronegative Donors (D-/R-): Time to Reexamine Donor CMV Serostatus
Creators: Madeleine R Heldman - Duke University
Julia A Messina - Duke University
Annette J Schlueter - University of Iowa
Mark J Lee - Duke University
Jennifer L Saullo - Duke University
Rachel A Miller - Duke University
Resource Type: Journal article
Publication Details: Clinical transplantation, Vol.39(1), e70073
Publisher: WILEY
DOI: 10.1111/ctr.70073
PMID: 39737614
ISSN: 1399-0012
eISSN: 1399-0012
Language: English
Date published: 01/2025
Academic Unit: Pathology
Record Identifier: 9984769786302771

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