Contemporary Cytomegalovirus (CMV) Infections in Low-Risk CMV Seronegative Recipients of Solid Organ Transplants From CMV Seronegative Donors (D−/R−): Time to Reexamine Donor CMV Serostatus

Background

Early posttransplant cytomegalovirus (CMV) infections in CMV seronegative solid organ transplant recipients (SOTR) with CMV seronegative donors (D−/R−) are often attributed transfusion-transmitted CMV. The prevalence of false-negative donor CMV serology in D−/R− SOTR with early CMV infections has not been explored.

Methods

We determined the frequency and characteristics of CMV DNAemia that occurred within 90 days of transplant among adult SOTR classified as D−/R− who underwent a first SOT at a single center between February 25, 2014 and February 25, 2024. Repeat donor CMV antibody testing was performed on stored donor sera if possible.

Results

Thirteen of 737 (1.8%) D−/R− SOTR from 12 donors developed CMV DNAemia within 90 days of transplant (median time to DNAemia: 28 days, interquartile range 23–42 days). Five (38%) recipients experienced CMV disease either before (n = 2) or after (n = 3) CMV DNAemia was identified, and five (38%) developed CMV antiviral resistance mutations during their course. Repeat CMV antibody testing was performed on sera from four donors to five recipients and was positive in three (75%) tested donors.

Conclusions

Early CMV infections in D−/R− SOTR are uncommon but associated with high morbidity. CMV transmission from organ donors with false negative CMV serology is an important source of early CMV infections in D−/R− SOTR. Clinicians should suspect and promptly report early CMV infections in D−/R− SOTR as potential donor-derived processes, regardless of donor and/or recipient transfusion histories. Reporting such cases is essential to promote broader investigations that may identify suboptimal donor CMV screening assays.