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. 2022 Jun 22:35:10332.
doi: 10.3389/ti.2022.10332. eCollection 2022.

Cytomegalovirus Management in Solid Organ Transplant Recipients: A Pre-COVID-19 Survey From the Working Group of the European Society for Organ Transplantation

Paolo Antonio Grossi  1 , Nassim Kamar  2 , Faouzi Saliba  3 , Fausto Baldanti  4   5 , Jose M Aguado  6 , Jens Gottlieb  7 , Bernhard Banas  8 , Luciano Potena  9
Affiliations

Cytomegalovirus Management in Solid Organ Transplant Recipients: A Pre-COVID-19 Survey From the Working Group of the European Society for Organ Transplantation

Paolo Antonio Grossi et al. Transpl Int. .

Abstract

Infections are leading causes of morbidity/mortality following solid organ transplantation (SOT) and cytomegalovirus (CMV) is among the most frequent pathogens, causing a considerable threat to SOT recipients. A survey was conducted 19 July-31 October 2019 to capture clinical practices about CMV in SOT recipients (e.g., how practices aligned with guidelines, how adequately treatments met patients' needs, and respondents' expectations for future developments). Transplant professionals completed a ∼30-minute online questionnaire: 224 responses were included, representing 160 hospitals and 197 SOT programs (41 countries; 167[83%] European programs). Findings revealed a heterogenous approach to CMV diagnosis and management and, sometimes, significant divergence from international guidelines. Valganciclovir prophylaxis (of variable duration) was administered by 201/224 (90%) respondents in D+/R- SOT and by 40% in R+ cases, with pre-emptive strategies generally reserved for R+ cases: DNA thresholds to initiate treatment ranged across 10-10,000 copies/ml. Ganciclovir-resistant CMV strains were still perceived as major challenges, and tailored treatment was one of the most important unmet needs for CMV management. These findings may help to design studies to evaluate safety and efficacy of new strategies to prevent CMV disease in SOT recipients, and target specific educational activities to harmonize CMV management in this challenging population.

Keywords: ESOT; cellular immunity; infection cytomegalovirus; organ transplantation; pre-emptive therapy; prophylaxis; survey.

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Conflict of interest statement

PG has been a consultant or member of an advisory committee for Angelini, Becton Dickinson, Biotest, Correvio, Gilead Sciences, Merck Sharpe & Dohme, Nordic Pharma, Paratek Pharmaceuticals, AlloVir, and Shire; and a speakers’ bureau member for Becton Dickinson, Biotest, Gilead Sciences, Merck Sharpe & Dohme, Pfizer, Atara, and Vertex. NK has been a speaker or an advisory board member for AbbVie, Amgen, Astellas, Biotest, Chiesi, CSL Behring, Gilead, Fresenius Medical Care, Merck Sharpe & Dohme, Neovii, Novartis Pharma, Sandoz, Sanofi, and Shire. FS has received speaker’s honoraria and/or research grants from Novartis, Astellas, Chiesi, Gilead, Merck Sharp & Dohme, Neovii, Sandoz, Pfizer, Biotest, Takeda, and Baxter. FB has received grants/research support from AB Analitica, DiaSorin, ELITechGroup, NTP, and Qiagen; he has also received honoraria or consultation fees from Biotest, DiaSorin, HUMABS, Merck Sharpe & Dohme, Qiagen, and Shire. JA has been a consultant and speakers’ bureau member for Astellas Pharma, Biotoscana, Gilead, Merck Sharpe & Dohme, Pfizer, Roche, and United Medical. LP has been a consultant for Novartis and Biotest and received speaker fees from AstraZeneca, Boehringer Ingelheim, Abbott, and Paragonix. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Disposition of study respondents according to medical specialty, and geographic distribution of respective transplant programs (A); transplantation practices within institutions (B,C); and median numbers of annual transplantations performed in respondents’ institutions (D). The 11 “other” HCPs included immunologists, hematologists, intensivists, pharmacologists and nurse practitioners.
FIGURE 2
FIGURE 2
Duration of prophylactic antiviral therapy for cytomegalovirus infection in (A) D+/R−, and (B) D+/R+. Proportion of respondents using prophylaxis in R+ patients (C). p < 0.01 across all groups. After correction for multiple comparisons, duration following lung transplantation was significantly different from all other groups. Antiviral therapy duration following heart transplantation was also significantly different from those following lung and liver transplantation.
FIGURE 3
FIGURE 3
Conditions impacting use of currently approved anti-CMV agents in solid organ transplant recipients. Scores 1–2 do not impact use; score 3 has moderate impact on use; scores 4–5 substantially impact use.
FIGURE 4
FIGURE 4
Reported thresholds for pre-emptive antiviral therapy initiation in different organ recipients from respondents using whole-blood polymerase chain reaction assays.
FIGURE 5
FIGURE 5
Perception among respondents regarding the importance of CMV-specific T cell response (A) at the time of the survey and (B) in 1–3 years.
See this image and copyright information in PMC

References

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