CMV Infection Following mRNA SARS-CoV-2 Vaccination in Solid Organ Transplant Recipients

Abstract

Cytomegalovirus (CMV) is a common herpes virus that infects 60%–100% of adults and is one of the main causes of infection after organ transplantation.1 In transplant recipients, CMV infection may occur because of transmission from the transplanted organ, reactivation of latent infection, or primary infection in a seronegative host.2 In solid organ transplants, CMV infection is associated with poor short-term and long-term outcomes including allograft function and survival.3-5 There are several factors that can lead to an increased risk of CMV primary infection and reactivation, including intensity of immunosuppression, use of lymphocyte-depleting therapies, acute rejection, and advanced age in the donor or recipient. Human leukocyte antigen mismatch, or immunologic incompatibility between donor and recipient based on white blood cell and tissue surface proteins; concurrent infections (such as with herpes virus 6 or 7); and genetic polymorphisms are also major risks for CMV reactivation.2 Coronavirus disease 2019 (COVID-19) has impacted healthcare in an unprecedented way since its emergence in late 2019. Outcomes with COVID-19 infection are worse for solid organ transplant recipients compared with the general population.6 It is possible that COVID-19 vaccination may lead to immune dysregulation in some solid organ transplant recipients, thereby increasing risks for CMV reactivation. 7 Here, we present 10 cases of CMV infection in solid organ transplant recipients shortly after COVID-19 mRNA vaccination