Risk factors for late-onset cytomegalovirus disease in donor seropositive/recipient seronegative kidney transplant recipients who receive antiviral prophylaxis

Authors



Ajit P. Limaye, MD, Department of Medical Microbiology, University of Washington Medical Center, Box 356174, 1959 NE Pacific Street, Seattle, WA 98195-6174, USA
Tel: +1 206 598 1041
Fax: +1 206 598 3884
E-mail: alimaye@medicine.washington.edu

Abstract

A.A. Boudreault, H. Xie, R.M. Rakita, J.D. Scott, C.L. Davis, M. Boeckh, A.P. Limaye. Risk factors for late-onset cytomegalovirus disease in donor seropositive/recipient seronegative kidney transplant recipients who receive antiviral prophylaxis.
Transpl Infect Dis 2011: 13: 244–249. All rights reserved

Background. Cytomegalovirus (CMV) disease occurs frequently after cessation of antiviral prophylaxis in CMV-seronegative kidney transplant recipients from seropositive donors (D+R−), and the risk factors are incompletely defined.

Method. We retrospectively assessed the incidence, clinical features, and risk factors for CMV disease in a cohort of D+R− kidney transplant recipients who received antiviral prophylaxis at a single US transplant center using descriptive statistics and Cox proportional hazards models.

Results. CMV disease developed in 29 of 113 (26%) D+R− patients at a median of 185 days (interquartile range 116–231 days) post transplant, including CMV syndrome (66%) and tissue invasive disease (34%). The incidence of CMV disease was higher in patients who underwent re-transplantation (57% vs. 24%) and this factor was independently associated with a higher risk of CMV disease in multivariable analysis (hazard ratio, 4.02; 95% confidence interval, 1.3–13; P=0.016). Other demographic and transplant variables were not independently associated with a risk of late-onset CMV disease.

Conclusions. Despite a comprehensive analysis of patient and transplant variables, only re-transplantation was identified as a risk factor for CMV disease in D+R− kidney transplant recipients who received antiviral prophylaxis, but had limited clinical predictive value. The development of novel laboratory markers to identify patients at greatest risk for CMV disease should be a priority for future studies.

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