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. 2025 Jul;57(7):2227-2235.
doi: 10.1007/s11255-025-04399-0. Epub 2025 Feb 4.

Secular trends in cytomegalovirus (CMV) risk and outcomes: results from a 10-year longitudinal cohort study in adult kidney transplant recipients

Amy Perry  1 , Karim Soliman  2   3   4 , Erika Andrade  5 , Zaid Mesmar  6 , Morgan Overstreet  6 , Tibor Fulop  2   3 , Isabel K Calimlim  6 , Courtney Harris  7 , David J Taber  6   8
Affiliations

Secular trends in cytomegalovirus (CMV) risk and outcomes: results from a 10-year longitudinal cohort study in adult kidney transplant recipients

Amy Perry et al. Int Urol Nephrol. 2025 Jul.

Abstract

Background: The goal of this study was to determine the secular trends in the incidence of CMV sero-mismatch (D+/R -) and if these trends meaningfully impact clinical outcomes.

Methods: This was a single-center longitudinal cohort study in adult kidney recipients transplanted between Jan 2012 and June 2021 with follow-up through June 2022. Baseline and follow-up data were collected. Univariate and multivariate statistics were used to analyze the data.

Results: 2,392 kidney transplants were performed during the study period; 132 patients did not meet inclusion criteria. The mean age was 52 years, 41% were female, 57% were black, and 19% were CMV D + /R -. The odds of being CMV high-risk increased by 6% each year (OR 1.06, 1.02-1.10 p = 0.003); 48% of the variability associated with CMV serostatus was explained by transplant year (R2 = 0.478, p = 0.002). Sequential modeling demonstrated that CMV D + /R - serostatus was a substantial risk factor for CMV infection (HR 5.7, 4.5-7.3), CMV disease (HR 8.4, 3.9-18.0), CMV resistance (HR 17.9, 3.8-84.2), CMV refractory infection (HR 35, 4-280), late CMV infection (HR 12.0, 8.3-17.1), acute rejection, and hospitalization for opportunistic infections. Secular trend analysis demonstrated that CMV infections, CMV resistance, and late CMV increased in incidence since 2012. The risks of CMV resistance and late infection was significantly influenced by D + /R - serostatus and transplant year, indicating that this risk is worsening over time.

Conclusion: The CMV D + /R - serostatus remains the single most important risk factor for CMV infection, disease, resistance, refractory infection, and late CMV, which appears to be increasing in magnitude.

Keywords: CMV; Cytomegalovirus infections; Follow-up studies; Kidney; Kidney transplantation; Longitudinal studies; Opportunistic infections; Risk factors; Secular; Transplant.

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Conflict of interest statement

Declarations. Conflict of interest: Ms Perry, Drs Soliman and Taber are current employees of the United States Veterans Health Administration. However, the opinions and views expressed in this paper are the Authors’ own and do not represent the official views or policies of the United States Veteran Health Administrations. Dr. Taber has research grants from Veloxis, Merck, CareDx and is an Advisory Board Member for Veloxis and CareDx. Ms. Perry and Dr Soliman are on the editorial board for Renal Failure.

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