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.