Abstract
Abstract: :
Purpose:The University of Washington has a well–recognized and long–established solid organ transplant (SOT) program, with approximately 300 transplants per year. The incidence of CMV disease is approximately 10% in this population but the prevalence of CMV retinitis (CMVR) in this group is unknown. CMVR has been diagnosed in past SOT recipients with serious permanent visual loss in some. In this study, we endeavor to establish the prevalence of CMVR and analyze risk factors in this vulnerable population. Methods:Ongoing prospective, observational study of SOT recipients (liver, kidney, pancreas, heart and lung) with recently diagnosed extra–ocular CMV disease, defined as infection associated with isolated whole CMV, proteins or nucleic acid in any body fluid or tissue. Subjects undergo standard ophthalmologic exam within four weeks of the diagnosis of extra–ocular CMV infection, including dilated ophthalmoscopy to assess for signs of retinitis. Results:Over a twelve month period, 17 eligible patients have been enrolled (approximate enrollment rate of 78%), including 1 lung, 1 pancreas, 3 heart, 3 kidney and 9 liver recipients. 9 had CMV syndrome (fever, leukopenia, CMV antigenemia), 6 had CMV enteritis/colitis, 2 had CMV pneumonitis and 1 had CMV hepatitis. Immunosuppressive agents included azathioprine, tacrolimus, mycophenolate mofetil, cyclosporine and prednisone. All but one patient received organs from seropositive donors. 3 patients were CMV seropositive prior to transplantation. All but one patient had received 1 – 6 months CMV prophylaxis with either ganciclovir or valganciclovir prior to CMV diagnosis. One developed CMV infection while on prophylaxis. All had been started on IV ganciclovir for extra–ocular CMV disease, mean = 8 days prior to eye exam (range 1 to 24 days). None of the patients admitted new ocular symptoms. On examination, none showed ophthalmoscopic evidence of current or previous CMVR. Conclusions:The prevalence of manifest or subclinical CMVR in the SOT population has been previously unclear. We have surveyed SOT patients early after the development of extra–ocular CMV infection and analyzed clinical and laboratory data to identify potential risk factors for CMVR. The prevalence of this form of CMV infection has declined to low levels, likely due to advances in medical measures to prevent rejection, pro–active anti–CMV therapy given early after transplantation and improved surveillance for opportunistic infection after SOT.
Keywords: cytomegalovirus • transplantation • retinitis