Improving the Assignment of Cytomegalovirus Infection Status in Adults and Children Awaiting Solid Organ Transplant

• Author / Creator

  Burton, Catherine EC

• Cytomegalovirus (CMV), a herpes-virus, is widespread in the human population as a lifelong and largely asymptomatic infection in immunocompetent people, but it is a major cause of morbidity in solid organ transplant (SOT) recipients. Knowledge of pre-transplant CMV infection status, generally determined using serology to detect IgG antibodies to CMV, is critical in stratifying the risk of CMV disease post-transplant and affects decisions regarding the use of anti-viral prophylaxis and enhanced surveillance including additional laboratory testing for CMV disease post-transplant. Unfortunately, serology-based determination of CMV infection status has limitations in situations where passive antibodies may lead to falsely positive CMV serology, such as in young infants who may have maternal antibody and in individuals who have received a recent transfusion of plasma-containing blood products. While guidelines suggest that CMV serology may be unreliable in infants less than 12 or 18 months of age, the time to clearance of passive maternal CMV IgG is not well established. Our first objective with this program of research was to gain insight into the age of clearance of passive maternal CMV IgG in infants to aid in identification of the group of infants in whom CMV serology may be unreliable due to passive maternal antibody. This was accomplished with a retrospective review of pre-transplant CMV serology and viral detection studies for all infants 12 months of age and in adults but lacked sensitivity in identifying true positive CMV infection status in young infants (12 months of age with potential passive antibody but further evaluation, with larger numbers of pre-SOT subjects, is needed. However, detection of CMV-specific CD4+ T cells should not be used in isolation to determine CMV infection status in CMV seropositive infants < 12 months with potential passive antibody.

• Subjects / Keywords

  • Cell Mediated Immunity Assay
  • Solid Organ Transplant
  • Nucleic Acid Amplification Testing
  • Cytomegalovirus

• Graduation date

  Fall 2017

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/R31J97Q5T

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.