To the Editor:
We read with interest the comment by Arasaratnam . He suggested that CMV exposure and/or infection could be a confounding factor explaining the compelling association we observed between EBV reactivation and allograft loss . Although interesting, we do not have data supporting this hypothesis. First, CMV infection and/or disease were not statistically more frequent in patients with EBV reactivation. As mentioned in our article , the incidence of CMV disease was only numerically higher in subjects with EBV reactivation (p = 0.187). Otherwise, we observed the same trends for CMV viremia (21% vs 16%, p = 0.169). Sixty-nine patients (18%) exhibited at least one positive CMV viremia during the first year posttransplant. Neither CMV exposure (HR 1.04 95% CI 0.60–1.78, p = 0.897) nor CMV viremia (HR 1.54 95%CI 0.84–2.82, p = 0.0164) was associated with graft loss. Thirty-three patients had both EBV and CMV viremia in the first year posttransplant. These patients had no increase in the risk of allograft failure as compared with those with only EBV positive viremia (HR 1.34 95% CI 063–2.72, p = 0.465). Of course, absence of evidence is not evidence of absence but no results in our study support a role for CMV in allograft failure.
aDepartment of Nephrology and Renal Transplantation, CHU Saint Jacques, Besançon, France
*Corresponding author: Didier Ducloux, email@example.com