Condition
Herpesvirus causing self-limiting infection in immunocompetent individuals, but with potentially severe consequences in immuno-suppressed transplant patients.
Individual at risk
Recipient
Guidance at RECRUITMENT
ACCEPTABLE
Guidance at CT
ACCEPTABLE
CMV IgG should be performed at CT to ascertain donor CMV serostatus.
Guidance at WORK-UP
Recommended testing at work-up:
CMV-IgG and IgM should be performed at work-up. If CMV IgM is postitive, CMV-PCR should be undertaken.
Testing outcomes and guidance
1)
CMV-IgM = negative, CMV-IgG = positive or negative
CMV-IgM = positive, CMV-IgG = positive, CMV-PCR negative
Status information should be reported to the transplant centre
With these combinations of serology and PCR, the donor can be cleared at workup. If there is a change of CMV status from CT to work-up stage, the transplant centre should be informed immediately.
CMV-IgG weak positive results should be validated with reference standard serology (e.g. immunoblot)
2)
CMV-IgM = positive and CMV-IgG = negative and CMV-PCR=negative
Immunoblots should be performed to validate the serology results. Results should be communicated with TC.
3) CMV-PCR = positive
Donor cannot be cleared. Inform transplant centre and discuss donor deferral
Justification for guidance
CMV can cause devastating complications in post-transplant recipients. Accurate donor CMV serostatus plays an important role in donor selection.
References
Pergam SA, Xie H, Sandhu R, et al. Efficiency and Risk Factors for CMV Transmission in Seronegative Hematopoietic Stem Cell Recipients. Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2012;18(9):1391-1400. doi:10.1016/j.bbmt.2012.02.008. [1]
Notes
Page created 7th March 2015