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Comparative Study
. 2021 Jul 25;18(14):3333-3341.
doi: 10.7150/ijms.62621. eCollection 2021.

The Incidence and Effect of Cytomegalovirus Disease on Mortality in Transplant Recipients and General Population: Real-world Nationwide Cohort Data

Sang Hoon Han  1 , Seul Gi Yoo  1 , Kyung Do Han  2 , Yeonju La  1 , Da Eun Kwon  1 , Kyoung Hwa Lee  1
Affiliations
Comparative Study

The Incidence and Effect of Cytomegalovirus Disease on Mortality in Transplant Recipients and General Population: Real-world Nationwide Cohort Data

Sang Hoon Han et al. Int J Med Sci. .

Abstract

Background: In addition to the conventional opportunistic infections in solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT) recipients, cytomegalovirus (CMV) infection is associated with various chronic inflammatory diseases or poor outcomes in non-immunocompromised critically ill patients. To evaluate the burden or outcome of CMV replication in non-transplant individuals, we compared the incidence rates (IRs) for CMV disease and all-cause mortality between SOT recipients, HSCT recipients, and non-transplant population. Methods: The SOT (N=16,368) and HSCT (N=10,206) cohorts between 2010 and 2015 were established using the WHO ICD-10 from the whole population-based large database of the Health Insurance Review & Assessment Service (HIRA). CMV cases, defined as symptomatic disease with isolation of virus, DNA, pp65 antigen, and pathology except CMV syndrome, were extracted with the unique codes for relief of medical costs of HIRA in the same dataset. Cox's proportional hazard regression analyses and log-rank test in the Kaplan-Meier curves were performed to compare all-cause mortality between the three groups. Results: The CMV IRs adjusted by age and sex were significantly higher in the SOT (adjusted IR [95% confidence intervals], 33.1 [28.8-38.0] per 1,000 person-years) and HSCT recipients (5.1 [4.6-6.1] per 1,000 person-years) than in the whole population (0.58 [0.49-0.67] per 100,000 person-years). However, SOT recipients with CMV (18/283, 6.4%) had significantly lower all-cause mortality than non-transplant individuals with CMV (207/1,258, 16.5%) (adjusted hazard ratio [95% CI], 0.42 [0.25-0.67], log-rank P < 0.001). Conclusion: These data suggest that CMV disease in patients without transplants is associated with poor outcomes.

Keywords: Cytomegalovirus; Disease; Hematopoietic stem cell transplantation; Incidence; Mortality; Population; Solid organ transplantation.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
Difference in incidence probability for development of CMV disease except CMV syndrome according to the transplant organ in solid organ transplantation recipients
Figure 2
Figure 2
All-cause mortality rates in solid organ transplantation recipients, hematopoietic stem cell transplantation recipients, and non-transplant individuals with CMV disease except CMV syndrome. *Log rank test. Aberrations: HSCT, hematopoietic stem cell transplantation; SOT, solid organ transplantation
See this image and copyright information in PMC

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