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. 2020 Jan 17;9(1):252.
doi: 10.3390/jcm9010252.

Cytomegalovirus Viremia after Living and Deceased Donation in Kidney Transplantation

Ulrich Jehn  1 , Katharina Schütte-Nütgen  1 , Joachim Bautz  1 , Hermann Pavenstädt  1 , Barbara Suwelack  1 , Gerold Thölking  1 , Hauke Heinzow  2 , Stefan Reuter  1
Affiliations

Cytomegalovirus Viremia after Living and Deceased Donation in Kidney Transplantation

Ulrich Jehn et al. J Clin Med. .

Abstract

Despite screening, effective anti-viral drugs and risk-balanced prophylaxis, cytomegalovirus (CMV) remains a major cause of morbidity in transplant patients. The objective of this study was to retrospectively analyze the risk factors associated with CMV viremia after kidney transplantation in a large European cohort with standardized valganciclovir prophylaxis in the present era. A special focus was placed on the comparison of living and postmortal donation. We conducted a longitudinal observational study involving 723 adult patients with a total of 3292 patient-years who were transplanted at our center between 2007 and 2015. Valganciclovir prophylaxis was administered over 100 days for CMV+ donors (D) or recipients (R), over 200 days for D+/R-, and none in D-/R-. A CMV+ donor, rejection episodes, and deceased donor transplantation were identified to be associated with increased incidences of CMV viremia. Although we did not find a reduced overall survival rate for patients with CMV viremia, it was associated with worse graft function. Since we observed a relevant number of CMV infections despite prescribing valganciclovir prophylaxis, a pre-emptive strategy in patients with (suspected) adherence restrictions could be favored. Our data can help transplant physicians educate their patients about their individual CMV risk and choose the most appropriate CMV treatment approach.

Keywords: CMV; Cytomegalovirus; Valganciclovir; antiviral prophylaxis; kidney transplantation; living donation; renal disease.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(A) Kaplan–Meier survival plot for onset of CMV viremia after transplantation, (Median: 7.2 months) and (B) for onset of CMV viremia after transplantation according to CMV match.
Figure 2
Figure 2
(A) Kaplan–Meier plot for recipient survival, Log-rank: p = 0.444 and (B) death-censored graft survival, p = 0.091 according to development of CMV infection.
Figure 2
Figure 2
(A) Kaplan–Meier plot for recipient survival, Log-rank: p = 0.444 and (B) death-censored graft survival, p = 0.091 according to development of CMV infection.
Figure 3
Figure 3
(A) eGFR levels after one year and (B) death-censored graft survival (Log-rank p = 0.974), according to CMV-mismatch.
Figure 3
Figure 3
(A) eGFR levels after one year and (B) death-censored graft survival (Log-rank p = 0.974), according to CMV-mismatch.
Figure 4
Figure 4
(A) Kaplan–Meier survival plots for the incidence of rejection episodes, p = 0.008 according to CMV viremia, and (B) for death-censored graft survival according to the different constellations of onset of CMV viremia and rejection episodes, p ≤ 0.001.
Figure 4
Figure 4
(A) Kaplan–Meier survival plots for the incidence of rejection episodes, p = 0.008 according to CMV viremia, and (B) for death-censored graft survival according to the different constellations of onset of CMV viremia and rejection episodes, p ≤ 0.001.
Figure 5
Figure 5
Kaplan–Meier survival plot for the development of CMV viremia, p ≤ 0.001, according to living versus postmortal donation.
Figure 6
Figure 6
(A) Kaplan–Meier survival plot for onset of CMV viremia, according to development of NODAT, Log-rank test: p = 0.004 and (B) for onset of BKV viremia, Log-rank: p = 0.652, according to development of CMV infection.
See this image and copyright information in PMC

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