Interactive Case Study

CMV Heart Transplant

Welcome to the Viracor Case Study Experience

Step inside a real-world clinical journey and explore how diagnostic insights can shape decisions in transplant care. This interactive experience follows a CMV heart transplant case from presentation through management—highlighting critical moments, testing strategies, and the impact of timely, informed choices.

As you move through each stage, your Viracor representative will guide you through the case, offering context, perspective, and opportunities to engage with the data.

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Case History

Your patient is a 65-year-old male who underwent a heart transplant.

  • CMV status: D+/R−
  • Underlying conditions include:
    • Ischemic cardiomyopathy
    • Diabetes
    • Obesity
    • Chronic kidney disease (CKD)

 

 

 

Institutional Protocols

Institutional Immunosuppression for Heart Transplant:

  • MMF (mycophenolate) 1500 mg q12h
  • Prednisone taper
  • Tacrolimus (target levels 7–10)
  • Renal sparing regimen: delayed introduction of tacrolimus

Institutional CMV Prophylaxis by Serostatus:

  • D+/R‑: 6 months
  • D+/R+: 6 months
  • D‑/R+: 3 months

CMV Treatment Regimen:

  • First‑line: Valganciclovir
  • Second‑line: Maribavir

Patient Regimen

Immunosuppression:

  • Induction: No T‑cell depletion
  • Maintenance: TAC / MMF / Prednisone
  • Prophylaxis: Valganciclovir (equivalent of 900 mg once daily, dose adjusted for renal function), Bactrim

 

Post-Operative Complications

  • Multiple GI symptoms related to MMF intolerance
  • Dehydration
  • Fluctuating kidney function with missed doses of medications

 

 

 

 

 

 

 

Testing and Interventions

CMV DNA:

  • At 4 months post‑transplant, patient developed breakthrough CMV viremia of 5470 IU/mL

Interventions:

  • MMF was stopped
  • IV ganciclovir was initiated
  • CMV resistance testing revealed UL97 mutation
  • Patient was switched to Maribavir

Follow-up:

  • At 6 months post‑transplant, patient had sustained clearance of CMV viremia
  • CMV therapy was stopped

 

Case Update

  • At 7 months post‑transplant, patient developed low‑level CMV viremia of 560 IU/mL
  • Two weeks later, CMV viremia increased to 4100 IU/mL
  • Resistance panel showed UL97 T409 mutation confirming Maribavir resistance

 

 

Testing and Interventions

  • Viracor CMV inSIGHT(TM) T Cell Immunity Panel ordered
  • CD4 interferon-gamma response below reference range (0.20%)
  • CD8 interferon-gamma response below reference range (0.20%)
  • Low CMV-specific immune response detected
  • Due to the patient’s viral load of 4100 IU/mL, the patient was treated with IV ganciclovir
  • After treatment course, patient cleared CMV viremia

 

 

Case Update

  • Six weeks after clearance, CMV inSIGHT™ T Cell Immunity Panel repeated
  • CD4 and CD8 interferon-gamma responses above reference range
  • CMV-specific immunity detected
  • CMV therapy discontinued

Case Outcome

CMV qPCR Follow-ups
  • One month later patient developed asymptomatic, low level CMV viremia (200-400 IU/mL)
  • Patient showed spontaneous clearance with followup testing, remained asymptomatic, and no further CMV treatment was required
  • Surveillance CMV qPCR was performed 3 months later and remained undetected

Relevant Testing

CMV inSIGHT

CMV inSIGHT™ T Cell Immunity

Review of some of the testing utilized for this patient reviewed in the case study:

  • CMV T Cell Immunity Panel:
    • Elevate CMV risk assessment beyond viral load with CMV inSIGHT TCIP, providing a functional measure of cell-mediated immunity to potentially help personalize prophylaxis and treatment decisions across the transplant continuum
  • CMV Antiviral Resistance
    • Characterize clinically relevant CMV resistance-associated mutations in antiviral target genes to inform interpretation of virologic non-response and support evidence-based therapeutic decision-making in transplant populations.

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