Plasma cytomegalovirus DNA load predicts outcomes in liver transplant recipients
Abstract Objective Cytomegalovirus (CMV) infection has a significant negative impact on liver transplant (LT) recipients. We aimed to evaluate the efficacy of real‐time DNA quantitative polymerase chain reaction (qPCR) in the early detection of CMV and predicting post‐transplant outcomes. Materials...
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| Format: | Article |
| Language: | English |
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Wiley
2021-03-01
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| Series: | Immunity, Inflammation and Disease |
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| Online Access: | https://doi.org/10.1002/iid3.371 |
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| author | Hao‐Chien Hung Po‐Jung Hsu Jin‐Chiao Lee Yu‐Chao Wang Chih‐Hsien Cheng Tsung‐Han Wu Ting‐Jung Wu Hong‐Shiue Chou Kun‐Ming Chan Wei‐Chen Lee Chen‐Fang Lee |
| author_facet | Hao‐Chien Hung Po‐Jung Hsu Jin‐Chiao Lee Yu‐Chao Wang Chih‐Hsien Cheng Tsung‐Han Wu Ting‐Jung Wu Hong‐Shiue Chou Kun‐Ming Chan Wei‐Chen Lee Chen‐Fang Lee |
| author_sort | Hao‐Chien Hung |
| collection | DOAJ |
| description | Abstract Objective Cytomegalovirus (CMV) infection has a significant negative impact on liver transplant (LT) recipients. We aimed to evaluate the efficacy of real‐time DNA quantitative polymerase chain reaction (qPCR) in the early detection of CMV and predicting post‐transplant outcomes. Materials and Methods This was a retrospective study that enrolled a total of 49 adult LT recipients between December 2016 and October 2019. Serial CMV qPCR were tested weekly. We used operating characteristic curve analysis to quantify qPCR replication numbers to decide the optimal threshold to predict posttransplant complications and overall survival. Results The optimal cut‐off value of 180 copies/ml (=164 IU/ml) was determined. We had 40 patients in the low qPCR group (<180 copies/ml) and nine patients in the high qPCR group (≥180 copies/ml). Higher qPCR was associated with more severe CMV disease, early allograft dysfunction, major posttransplant complications, longer ICU stays, and lower 2‐year overall survival (OS; all p < .05). In the univariate logistic regression model, persistent DNAemia ≥ 4 weeks after anti‐CMV treatment, coexisted bacterial and/or fungal infection, and high CMV qPCR ≥ 180 copies/ml with p < .100. High CMV qPCR ≥ 180 copies/ml (p = .016; hazard ratio [HR] = 19.5; 95% confidence interval [CI] = 1.73–219.49) remained to be the only independent risk factors for major complication by the multivariate analysis. The overall 2‐year OS rates were 92.5% and 66.7% in the low and the high qPCR group, respectively (p = .030). Conclusion Our findings support evidence that qPCR is effective in detecting CMV infection provides an objective perspective in predicting posttransplant outcomes. High plasma CMV DNA load (defined as CMV qPCR ≥ 180 copies/ml or 164 IU/ml) not only indicates a hazard in developing major posttransplant complications but also associates with prolonged and refractory treatment courses. |
| format | Article |
| id | doaj-art-c38e5da3230e4b51a397d5c2b6dcd75f |
| institution | DOAJ |
| issn | 2050-4527 |
| language | English |
| publishDate | 2021-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Immunity, Inflammation and Disease |
| spelling | doaj-art-c38e5da3230e4b51a397d5c2b6dcd75f2025-08-20T03:08:21ZengWileyImmunity, Inflammation and Disease2050-45272021-03-019113414310.1002/iid3.371Plasma cytomegalovirus DNA load predicts outcomes in liver transplant recipientsHao‐Chien Hung0Po‐Jung Hsu1Jin‐Chiao Lee2Yu‐Chao Wang3Chih‐Hsien Cheng4Tsung‐Han Wu5Ting‐Jung Wu6Hong‐Shiue Chou7Kun‐Ming Chan8Wei‐Chen Lee9Chen‐Fang Lee10Department of Liver and Transplantation Surgery Chang‐Gung Memorial Hospital at Linkou Taoyuan City TaiwanDepartment of General Surgery Chang‐Gung Memorial Hospital at Linkou Taoyuan City TaiwanDepartment of Liver and Transplantation Surgery Chang‐Gung Memorial Hospital at Linkou Taoyuan City TaiwanDepartment of Liver and Transplantation Surgery Chang‐Gung Memorial Hospital at Linkou Taoyuan City TaiwanDepartment of Liver and Transplantation Surgery Chang‐Gung Memorial Hospital at Linkou Taoyuan City TaiwanDepartment of Liver and Transplantation Surgery Chang‐Gung Memorial Hospital at Linkou Taoyuan City TaiwanDepartment of Liver and Transplantation Surgery Chang‐Gung Memorial Hospital at Linkou Taoyuan City TaiwanDepartment of Liver and Transplantation Surgery Chang‐Gung Memorial Hospital at Linkou Taoyuan City TaiwanDepartment of Liver and Transplantation Surgery Chang‐Gung Memorial Hospital at Linkou Taoyuan City TaiwanDepartment of Liver and Transplantation Surgery Chang‐Gung Memorial Hospital at Linkou Taoyuan City TaiwanDepartment of Liver and Transplantation Surgery Chang‐Gung Memorial Hospital at Linkou Taoyuan City TaiwanAbstract Objective Cytomegalovirus (CMV) infection has a significant negative impact on liver transplant (LT) recipients. We aimed to evaluate the efficacy of real‐time DNA quantitative polymerase chain reaction (qPCR) in the early detection of CMV and predicting post‐transplant outcomes. Materials and Methods This was a retrospective study that enrolled a total of 49 adult LT recipients between December 2016 and October 2019. Serial CMV qPCR were tested weekly. We used operating characteristic curve analysis to quantify qPCR replication numbers to decide the optimal threshold to predict posttransplant complications and overall survival. Results The optimal cut‐off value of 180 copies/ml (=164 IU/ml) was determined. We had 40 patients in the low qPCR group (<180 copies/ml) and nine patients in the high qPCR group (≥180 copies/ml). Higher qPCR was associated with more severe CMV disease, early allograft dysfunction, major posttransplant complications, longer ICU stays, and lower 2‐year overall survival (OS; all p < .05). In the univariate logistic regression model, persistent DNAemia ≥ 4 weeks after anti‐CMV treatment, coexisted bacterial and/or fungal infection, and high CMV qPCR ≥ 180 copies/ml with p < .100. High CMV qPCR ≥ 180 copies/ml (p = .016; hazard ratio [HR] = 19.5; 95% confidence interval [CI] = 1.73–219.49) remained to be the only independent risk factors for major complication by the multivariate analysis. The overall 2‐year OS rates were 92.5% and 66.7% in the low and the high qPCR group, respectively (p = .030). Conclusion Our findings support evidence that qPCR is effective in detecting CMV infection provides an objective perspective in predicting posttransplant outcomes. High plasma CMV DNA load (defined as CMV qPCR ≥ 180 copies/ml or 164 IU/ml) not only indicates a hazard in developing major posttransplant complications but also associates with prolonged and refractory treatment courses.https://doi.org/10.1002/iid3.371cytomegalovirusliver transplantoutcomereal‐time qPCRviral load |
| spellingShingle | Hao‐Chien Hung Po‐Jung Hsu Jin‐Chiao Lee Yu‐Chao Wang Chih‐Hsien Cheng Tsung‐Han Wu Ting‐Jung Wu Hong‐Shiue Chou Kun‐Ming Chan Wei‐Chen Lee Chen‐Fang Lee Plasma cytomegalovirus DNA load predicts outcomes in liver transplant recipients Immunity, Inflammation and Disease cytomegalovirus liver transplant outcome real‐time qPCR viral load |
| title | Plasma cytomegalovirus DNA load predicts outcomes in liver transplant recipients |
| title_full | Plasma cytomegalovirus DNA load predicts outcomes in liver transplant recipients |
| title_fullStr | Plasma cytomegalovirus DNA load predicts outcomes in liver transplant recipients |
| title_full_unstemmed | Plasma cytomegalovirus DNA load predicts outcomes in liver transplant recipients |
| title_short | Plasma cytomegalovirus DNA load predicts outcomes in liver transplant recipients |
| title_sort | plasma cytomegalovirus dna load predicts outcomes in liver transplant recipients |
| topic | cytomegalovirus liver transplant outcome real‐time qPCR viral load |
| url | https://doi.org/10.1002/iid3.371 |
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