2011 - TID Conference
2.1 - Is There a Role for CMV Vaccination in Transplant Patients?
Presenter: Paul, Griffiths, London, United Kingdom
Authors: Paul Griffiths
Is There a Role for CMV Vaccination in Transplant Patients?
Paul D. Griffiths, University College London, UK
Cytomegalovirus (CMV) can be transmitted from the donor to cause primary infection in a CMV seronegative recipient or reinfection in a CMV seropositive recipient. In addition, latent CMV in the recipient can reactivate post-transplant. The severity of these three types of infection can be ranked: primary is worse than reinfection which is worse than reactivation. This natural history of infection illustrates that immunity acquired from a previous infection can moderate the pathogenicity of CMV. This conclusion is supported by quantitative studies of CMV viral load where a greater burden (whether measured as duration of viraemia, peak viral load or area under the curve) is seen in those with primary infection, then reinfection with reactivation having the lowest values.
To determine if prior immunisation can do likewise, we randomised seronegative and seropositive recipients awaiting transplantation of a kidney or a liver to receive a placebo or a vaccine consisting of CMV glycoprotein B plus MF59 adjuvant. The results provide encouragement for this approach whose practicalities will be discussed.
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