Cytomegalovirus infection after kidney transplantation and long-term graft loss

Nefrologia. 2017 Sep-Oct;37(5):515-525. doi: 10.1016/j.nefro.2016.11.018.
[Article in English, Spanish]

Abstract

Background: Despite the use of prevention strategies, cytomegalovirus (CMV) infection is the most common viral complication after renal transplant and its impact on long-term outcomes is still open to debate.

Objective: To evaluate the incidence of CMV infection and disease during the use of prevention strategies in our centre and to analyse the association between CMV infection and long-term patient and graft survival and other potentially clinical events related with CMV.

Methods: We reviewed the medical records of 377 recipients of kidney transplants performed between January 1998 and December 2008. Kaplain-Meier survival curve analysis was performed to analyse graft and patient survival by CMV infection/disease and Cox proportional hazards regression was used to identify factors associated with CMV infection/disease, graft loss and mortality.

Results: The incidence of CMV infection was 34.7% and CMV disease was 9.5%. Patient and graft survival was significantly lower in patients with CMV infection/disease. CMV infection/disease was associated with a higher risk of graft loss (HR 1.91, 95% CI 1.09-3.36, p=0.023), but not with a higher mortality (HR 1.29, 95% CI 0.7-2.38, p=0.4).

Conclusion: CMV replication after renal transplant is a risk factor for long-term graft loss but not mortality. Prevention strategies decrease post-transplant CMV infection and disease.

Keywords: Cytomegalovirus infection; Graft loss; Infección por citomegalovirus; Kidney transplant; Mortalidad; Mortality; Pérdida injerto; Trasplante renal.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Adult
  • Antiviral Agents / therapeutic use
  • Cytomegalovirus Infections / drug therapy
  • Cytomegalovirus Infections / epidemiology*
  • Cytomegalovirus Infections / etiology
  • Cytomegalovirus Infections / prevention & control
  • Female
  • Ganciclovir / administration & dosage
  • Ganciclovir / analogs & derivatives
  • Ganciclovir / therapeutic use
  • Graft Survival
  • Humans
  • Immunosuppressive Agents / adverse effects
  • Incidence
  • Kaplan-Meier Estimate
  • Kidney Transplantation* / adverse effects
  • Male
  • Middle Aged
  • Phosphoproteins / blood
  • Postoperative Complications / drug therapy
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control
  • Proportional Hazards Models
  • Reoperation
  • Retrospective Studies
  • Risk Factors
  • Tissue Donors
  • Valganciclovir
  • Viral Matrix Proteins / blood
  • Virus Activation

Substances

  • Antiviral Agents
  • Immunosuppressive Agents
  • Phosphoproteins
  • Viral Matrix Proteins
  • cytomegalovirus matrix protein 65kDa
  • Valganciclovir
  • Ganciclovir