Predicting and preventing cytomegalovirus infection in transplant recipients

Transplantation is a life-saving procedure for patients with end-stage organ disease, but requires immunosuppressive medications to prevent rejection. This increases risk and severity of infections that don’t normally affect healthy individuals, which contribute significantly to morbidity and mortality. One of the most common and significant of these is cytomegalovirus (CMV) which causes clinical disease and indirect effects such as rejection, secondary infections and decreased survival. Highly effective antivirals are available, but predicting at-risk patients to target their use is difficult. A number of immune biomarkers are now available that can measure different aspects of the immune system. Early data suggests that some of these are able to identify patients at high risk for CMV infection, who could then be targeted with interventions such as extended antiviral prophylaxis, reduction in immunosuppression or more intensive viral load monitoring. This clinical research project aims to understand the acquisition of CMV-specific immunity in solid organ transplant recipients, and how that differs between patients who have previously had CMV infection before their transplant, and those that acquire it from their donor. It aims to define the frequency and severity of CMV in various subgroups, explore the role of several immune biomarkers in the prediction of CMV infection and understand the benefits and risks of extended antiviral prophylaxis. It will be based on an existing retrospective cohort of lung transplant recipients, but additional clinical data collection will be needed. It will involve statistical analyses and other clinical research methodologies but no laboratory work. Previous experience using R is desirable but not essential. It will set the groundwork for future clinical trials of different preventative strategies. It is a collaborative project involving both the infectious diseases department (Dr Bradley Gardiner, Professor Anton Peleg) and lung transplant department (Professor Glen Westall). The specific scope of work can be adapted to suit the interests of the student.