Abstract
We investigated the value of monitoring CMV antigenemia during and after antiviral therapy for CMV disease. During the study period, 10 out of 214 renal transplant recipients were treated for CMV disease, receiving a total of 14 courses of treatment. Antigenemia decreased within 7 days after onset of treatment in eight of nine courses associated with a rapid clinical recovery. In three courses with a slow or absent response, antigenemia levels initially increased. Monitoring antigenemia was helpful in differentiating persisting CMV disease from other opportunistic infections and rejection. Relapses of CMV disease were preceded by rises in antigenemia. Viral isolation became negative within 3 days after initiation of ganciclovir, irrespective of the clinical response. Antigenemia is a marker of the effect of ganciclovir on CMV replication in vivo, and its monitoring may be valuable in the management of patients with severe CMV disease.
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Berg AP van den, Bij W van der, Son WJ van, Anema J, Giessen M van der, Schirm J, Tegzess AM, The TH (1989) Cytomegalovirus-antigenemia as a useful marker of symptomatic cytomegalovirus disease after renal transplantation: a report of 130 consecutive patients. Transplantation 48: 991–995
Berg AP van den, Bij W van der, Giessen M van der, The TH, Son WJ van (1990) Early identification of patients at risk for severe cytomegalovirus disease after renal transplantation using the immediate early antigenemia assay. Transplant Proc 22: 1800–1802
Berg AP van den, Klompmaker IJ, Haagsma EB, Scholten-Sampson A, Bijleveld CMA, Schirm J, Giessen M van der, Slooff MJH, The TH (1991) Antigenemia in the diagnosis and monitoring of active CMV infection after liver transplantation. J Infect Dis 164: 265–270
Berg AP van den, Tegzess AM, Scholten-Sampson A, Giessen M van der, The TH, Son WJ van (1991) Quo vadis? The clinical dilemma of simultaneous cytomegalovirus infection and steroidresistant rejection. Transplantation 52: 1081–1083
Bij M van der, Torensma R, Son WJ van, Anema J, Schirm J, Tegzess AM, The TH (1988) Rapid immunodiagnosis of active cytomegalovirus infection by monoclonal antibody staining of blood leukocytes. J Med Virol 25: 179–188
Bij W van der, Schirm J, Torensma R, Son WJ van, Tegzess AM, The TH (1989) Comparison between viremia and antigenemia for detection of cytomegalovirus in blood. J Clin Microbiol 26: 2531–2535
Boland GJ, Gast GC de, Hene RJ, Janbroes G, Donckerwolcke R, The TH, Mudde GC (1990) Early detection of active cytomegalovirus (CMV) infection after heart and kidney transplantation by testing for immediate early antigenemia and influence of cellular immunity on the occurrence of CMV infection. J Clin Microbiol 28: 2069–2075
Dorp WT van, Jonges E, Jiwa NM, Gemert W van, Es LA van, Ploem JS, The TH, Woude FJ van der (1990) Symptomatic cytomegalovirus infections identified by image cytometry and other parameters for CMV infection. Transplant Int 3: 212–216
Drew WL, Miner RC, Bush DF, Follansbee SE, Gullett J, Mehalko SG, Gordon SM, Owen WF, Matthews TR, Buhles WC, DeArmond B (1991) Prevalence of resistance in patients receiving ganciclovir for serious cytomegalovirus infection. J Infect Dis 163: 716–719
Dunn DL, Mayoral JL, Gillingham KJ, Loeffler CM, Brayman KL, Kramer MA (1991) Treatment of invasive cytomegalovirus disease in solid organ transplant patients with ganciclovir. Transplantation 51: 98–106
Enrice A, Jordan MC, Chace BA, Fletcher C, Chinnock BJ, Balfour HH Jr (1987) Ganciclovir treatment of cytomegalovirus disease in transplant recipients and other immunocompromised hosts. JAMA 257: 3082–3087
Enrice A, Chou S, Biron KK, Stanat SC, Balfour HH Jr, Jordan MC (1989) Progressive disease due to ganciclovir-resistant cytomegalovirus in immunocompromised patients. N Engl J Med 320: 289–293
Faulds D, Heel RC (1990) Ganciclovir. A review of its antiviral activity, pharmacokinetic properties and therapeutic efficacy in cytomegalovirus infections. Drugs 39: 597–638
Giessen M van der, Berg AP van den, Bij W van der, Postma S, Son WJ van, The TH (1990) Quantitative measurement of CMV-specific IgG- and IgM-antibodies in relation to CMV antigenemia and disease activity in kidney transplantation with active CMV infection. Clin Exp Immunol 80: 56–61
Grundy JE, Shanley JD, Griffiths PD (1987) Is cytomegalovirus interstitial pneumonitis in transplant recipients an immunopathological condition? Lancet II: 996–999
Harbison MA, De Girolani PC, JenkinsRL, Hammer SM (1988) Ganciclovir therapy of severe cytomegalovirus infection in solidorgan transplant recipients. Transplantation 46: 82–88
Jennens ID, Lucas CR, Sandland AM, Maclean H, Hayes K (1990) Cytomegalovirus cultures during maintenance DHPG therapy for cytomegalovirus (CMV) retinitis in acquired immunodeficiency syndrome (AIDS). J Med Virol 30: 42–44
Metselaar HJ, Weimar W (1989) Cytomegalovirus infection and renal transplantation. J Antimicrob Chemother 23 [Suppl E]: 37–47
Paya CV, Hermans PE, Smith TF, Rakela J, Wiesner RH, Krom RAF, Torres VE, Sterioff S, Wilkowske CJ (1988) Efficacy of ganciclovir in liver and kidney transplant recipients with severe cytomegalovirus infection. Transplantation 46: 229–234
Ravello MG, Percivale E, Zavattoni M, Parea M, Grossi P, Gerna G (1989) Detection of human cytomegalovirus immediate early antigen in leukocytes as a marker of viremia in immunocompromised patients. J Med Virol 29: 88–93
Rubin RH (1988) Infections in the patient after renal and liver transplantation. In: Rubin RH, Young LS (eds) Clinical approach to infections in the immunocompromised patient. Plenum, New York, pp 557–583
Schirm J, Timmerije W, Bij W van der, The TH, Wilterdink JB, Tegzess AM, Son WJ van, Schroeder FP (1987) Rapid detection of infectious cytomegalovirus in blood with the aid of monoclonal antibodies. J Med Virol 23: 31–40
Shepp DH, Dandliker PS, Miranda P de, Burnette TC, Cederberg DM, Kirk LE, Meyers JD (1985) Activity of 9-[2-hydroxy-1-(hydroxymethyl)ethoxymethyl]guanine in the treatment of cytomegalovirus pneumonia. Ann Intern Med 103: 368–373
Snydman DR (1988) Ganciclovir therapy for cytomegalovirus disease associated with renal transplants. Rev Infect Dis 10 [Suppl 3]: 554–562
Son WJ van, The TH (1990) Cytomegalovirus infection after transplantation: an update. Transplant Int 2: 147–164
Son WJ van, Tegzess AM, The TH, Duipmans J, Slooff MJH, Mark TW van der, Peset R (1987) Pulmonary dysfunction is common during a cytomegalovirus infection after renal transplantation, even in asymptomatic patients: possible relationship with complement activation. Am Rev Respir Dis 136: 580–585
Stoffel M, Gianello P, Squifflet JP, Pirson Y, Alexandre GPJ (1988) Effects of 9-[2-hydroxy-1-(hydroxymethyl)ethoxymethyl]-guanine (DHPG) cytomegalovirus pneumonitis after renal transplantation. Transplantation 46: 594–595
The TH, Bij W van der, Berg AP van den, Giessen M van der, Weits J, Sprenger HG, Son WJ van (1990) Cytomegalovirus antigenemia. Rev Infect Dis 12: S737–744
Thomson MH, Jeffries DJ (1989) Ganciclovir therapy in iatrogenically immunosuppressed patients with cytomegalovirus disease. J Antimicrob Chemother 23 [Suppl E]: 61–70
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van den Berg, A.P., Tegzess, A.M., Scholten-Sampson, A. et al. Monitoring antigenemia is useful in guiding treatment of severe cytomegalovirus disease after organ transplantation. Transplant Int 5, 101–107 (1992). https://doi.org/10.1007/BF00339224
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DOI: https://doi.org/10.1007/BF00339224