Are the patterns of cytomegalovirus viral load seen after solid organ transplantation affected by circadian rhythm?
Rafferty H., Murray MJ., Tam JCH., Macfarlane A., Smith C., Lumley SF., Atabani S., McKeating JA., Sharma D., Reeves M., Whitmore D., Griffiths P.
BACKGROUND: Cytomegalovirus (CMV) is an important opportunistic pathogen following transplantation. Some virological variation in post-transplant patients is explained by donor and recipient CMV serostatus, but not all. Circadian variability of herpesviruses has been described, so we investigated the effect of time of day of transplant on CMV viremia post-transplant. METHODS: We performed a retrospective analysis of 1517 patients receiving liver or kidney allografts at a single center from 2002-2018. All patients were managed by pre-emptive therapy with CMV viremia monitoring post-transplant. Circulatory arrest and reperfusion time of donor organ were categorized into four periods. Patients were divided into serostatus groups based on previous CMV infection in donor and recipient. CMV viremia parameters were compared between time categories for each group. Factor analysis of mixed data (FAMD) was used to interrogate this complex dataset. RESULTS: Live transplant recipients were less likely to develop viremia than recipients of deceased-donor organs (48% vs. 61%, p<0.001). After controlling for this, there was no evidence of time-of-day of transplant affecting CMV parameters in any serostatus group by logistic regression or FAMD. DISCUSSION: We found no evidence for a circadian effect of transplant on CMV viremia, but these novel results warrant confirmation by other centers.