Possible circadian effect on cytomegalovirus post-transplant
Research type
Research Study
Full title
Possible circadian effect on cytomegalovirus after renal or liver transplant
IRAS ID
249410
Contact name
Paul Griffiths
Contact email
Sponsor organisation
Royal Free London NHS Foundation Trust
Duration of Study in the UK
1 years, 11 months, 30 days
Research summary
Summary of Research
Patients who need a replacement kidney or liver are given immunosuppressive drugs to reduce organ rejection after transplant. These drugs also impair immune system control of virus infections. The most common and most serious virus infection after transplant is cytomegalovirus (CMV). We routinely monitor all patients for evidence of CMV DNA in their blood. If it is detected, patients are treated with the antiviral drug valganciclovir until the CMV DNA becomes undetectable. This strategy of pre-emptive therapy is highly effective so that patients nowadays only rarely develop disease due to CMV.Patients can be divided into 4 groups depending on whether the organ donor or recipient has antibodies to CMV. The proportion of patients who develop CMV viraemia and who need treatment is significantly different in the 4 groups. Although this is useful in clinical practice for comparing patients between groups, there still remains substantial variation within each group. We would like to identify factors that explain this variation so that we can refine our predictions of which patients are most at risk.
There is increasing evidence that virus infections are influenced by the time of day at which infection occurs. We wish to ask whether circadian rhythms could explain some of the variation seen in patients having a kidney or liver transplant. We already have a database with all of the CMV measurements. We now need to expand this to show the time of day when the donor organ was harvested and then transplanted. We will examine each of the CMV subgroups to see if there is a statistical association between CMV viraemia and time of transplant. To achieve this, we will not need to contact the patients or request any additional samples. The clinical database will have the results pseudo-anonymised before statistical analysis.
Summary of Results
We did not find that the time of day of liver or kidney transplant affected if patients got cytomegalovirus (CMV) afterwards. We also did not find any difference in CMV infection depending on the season the transplant happened in. We did find more CMV infections in patients that received an organ from a deceased donor, compared to an alive donor.REC name
South Central - Oxford B Research Ethics Committee
REC reference
18/SC/0534
Date of REC Opinion
25 Sep 2018
REC opinion
Favourable Opinion