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. 2025 Sep 18:16:1618748.
doi: 10.3389/fimmu.2025.1618748. eCollection 2025.

Clinical management and burden of cytomegalovirus in D+/R-Kidney transplant recipients in Canada

John Gill  1 , Andrew A House  2 , Zain Chagla  3 , Jean Tchervenkov  4 , S Joseph Kim  5 , Amanda Vinson  6 , Carlos Cervera  7 , Paul A Keown  1 , Sonia Lai Wing Sun  8 , Christina Khoury  8 , Christiane Ghakis  8
Affiliations

Clinical management and burden of cytomegalovirus in D+/R-Kidney transplant recipients in Canada

John Gill et al. Front Immunol. .

Erratum in

Abstract

Purpose: To document prophylactic practices, infection patterns, and disease burden to inform strategies for CMV management in high-risk kidney transplant recipients.

Methods: A retrospective cohort of 311 consecutive CMV D+/R- kidney recipients were enrolled from 7 Canadian programs over 4 years (2018-2021) to provide data on demographic, clinical, therapeutic and health resource use during the 1st year post-transplant.

Results: Themedian age was 58 (46, 67) years, 69% were male, and 53% were White. Diabetes was the principal cause of kidney failure (19%). 208 (69%) received a deceased donor graft; 76 (24%) had ATG induction, and 84% had maintenance therapy with tacrolimus and MMF/MPA ± prednisone. All received antiviral prophylaxis, 90% with valganciclovir, for a median of 180 days. 106 (34%) developed CMV viremia (median peak viral load 14,224 IU/ml) at a median of 218 days, of whom 46 (43%) had CMV disease and 15 (14%) had recurrent infection. Myelotoxicity occurred in 121 (39%) patients at a median of 88 days, lasting a median of 30 days. Opportunistic infections occurred in 119 patients (38%) at a median of 53 days. 141 patients (45%) were hospitalized, 50 (16%) more than once. 20 patients (6%) had biopsy-confirmed rejection, and 293 (94%) were alive with a functioning graft at 1 year.

Conclusion: Current prophylaxis strategies fail to prevent CMV infection in 34% of high-risk patients. Myelotoxicity, opportunistic infection, reduced immunosuppression, and hospitalization remain common and serious complications. More effective and less toxic personalized treatment strategies are required to minimize these risks and burdens.

Keywords: antiviral prophylaxis and treatment; cytomegalovirus; graft failure; hospitalization; immunosuppression; kidney transplantation; leukopenia; superinfection.

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Conflict of interest statement

PK is a Director of Syreon Corporation which conducted the study on behalf of Merck Canada Inc. and the investigators. SS, CK and CG were employees of Merck Canada Inc. at the time of the trial/study and may hold stock in the company. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Cumulative incidence of CMV infection following renal transplantation.
Figure 2
Figure 2
Cumulative incidence of myelotoxicity following transplantation.
Figure 3
Figure 3
Cumulative incidence of opportunistic infection following transplantation.
Figure 4
Figure 4
Cumulative incidence of re-hospitalization following transplantation.
Figure 5
Figure 5
Probability of recipient survival with a functioning kidney graft following transplant by donor source.
Figure 6
Figure 6
Probability of recipient survival with a functioning kidney graft following transplant by CMV infection.
See this image and copyright information in PMC

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