BACKGROUND: Cytomegalovirus (CMV) disease is a serious infection after kidney transplantation. The risk factors and the impact of CMV disease in African-American (AA) kidney transplant patients have not been well characterized. METHODS: We performed a retrospective analysis on 448 AA patients transplanted between 1996 and 2005. A 3-month universal chemoprophylaxis with ganciclovir or valganciclovir was administered to CMV donor-positive/recipient-negative (D+/R-) patients and to those treated with anti-thymocyte globulin for rejection, but not routinely to those with other D/R serostatus. RESULTS: A total of 31 AA patients (7%) developed clinical CMV disease. Compared with other D/R serostatus groups, the D+/R- group had the highest 3-year cumulative incidence of CMV disease (16.9% vs. 6.3% in D+/R+, 4.9% in D-/R+, and 2.4% in D-/R-). The D+/R- group also had the worst 3-year death-censored allograft survival (75% vs. 92% in D+/R+, 94% in D-/R+, and 96% in D-/R-, log-rank P = 0.01). Multivariate analysis found that D+/R- serostatus (odds ratio [OR] 5.4, 95% confidence interval [CI] 0.6-48.2, P = 0.003) and donor age > 60 years (OR 9.1, 95% CI 1.3-65, P = 0.03) were independent risk factors for CMV disease. CONCLUSION: The D+/R- group has the highest incidence of CMV disease and the worst 3-year renal allograft survival despite 3-month universal prophylaxis. Prolonged chemoprophylaxis may be needed to prevent the late development of CMV disease and to improve allograft survival in the high-risk group of AA kidney transplant recipients.
BACKGROUND:Cytomegalovirus (CMV) disease is a serious infection after kidney transplantation. The risk factors and the impact of CMV disease in African-American (AA) kidney transplant patients have not been well characterized. METHODS: We performed a retrospective analysis on 448 AA patients transplanted between 1996 and 2005. A 3-month universal chemoprophylaxis with ganciclovir or valganciclovir was administered to CMV donor-positive/recipient-negative (D+/R-) patients and to those treated with anti-thymocyte globulin for rejection, but not routinely to those with other D/R serostatus. RESULTS: A total of 31 AA patients (7%) developed clinical CMV disease. Compared with other D/R serostatus groups, the D+/R- group had the highest 3-year cumulative incidence of CMV disease (16.9% vs. 6.3% in D+/R+, 4.9% in D-/R+, and 2.4% in D-/R-). The D+/R- group also had the worst 3-year death-censored allograft survival (75% vs. 92% in D+/R+, 94% in D-/R+, and 96% in D-/R-, log-rank P = 0.01). Multivariate analysis found that D+/R- serostatus (odds ratio [OR] 5.4, 95% confidence interval [CI] 0.6-48.2, P = 0.003) and donor age > 60 years (OR 9.1, 95% CI 1.3-65, P = 0.03) were independent risk factors for CMV disease. CONCLUSION: The D+/R- group has the highest incidence of CMV disease and the worst 3-year renal allograft survival despite 3-month universal prophylaxis. Prolonged chemoprophylaxis may be needed to prevent the late development of CMV disease and to improve allograft survival in the high-risk group of AA kidney transplant recipients.
Authors: Atul Humar; P Peeters; D Abramowicz; A Humar; Y Lebranchu; I Hauser; A Jardine; A P Limaye; F Vincenti; J D Punch; E Blumberg Journal: Am J Transplant Date: 2011-01 Impact factor: 8.086
Authors: A Humar; Y Lebranchu; F Vincenti; E A Blumberg; J D Punch; A P Limaye; D Abramowicz; A G Jardine; A T Voulgari; J Ives; I A Hauser; P Peeters Journal: Am J Transplant Date: 2010-03-26 Impact factor: 8.086
Authors: Scott M Palmer; Ajit P Limaye; Missy Banks; Dianne Gallup; Jeffrey Chapman; E Clinton Lawrence; Jordan Dunitz; Aaron Milstone; John Reynolds; Gordon L Yung; Kevin M Chan; Robert Aris; Edward Garrity; Vincent Valentine; Jonathan McCall; Shein-Chung Chow; Robert Duane Davis; Robin Avery Journal: Ann Intern Med Date: 2010-06-15 Impact factor: 25.391
Authors: P-Y Fan; V B Ashby; D S Fuller; L E Boulware; A Kao; S P Norman; H B Randall; C Young; J D Kalbfleisch; A B Leichtman Journal: Am J Transplant Date: 2010-04 Impact factor: 8.086
Authors: Fu L Luan; Linda J Stuckey; Jeong M Park; Daniel Kaul; Diane Cibrik; Akinlolu Ojo Journal: J Am Soc Nephrol Date: 2009-09-17 Impact factor: 10.121
Authors: Rafael San Juan; José Maria Aguado; Carlos Lumbreras; Jesus Fortun; Patricia Muñoz; Joan Gavalda; Francisco Lopez-Medrano; Miguel Montejo; German Bou; Marino Blanes; Antonio Ramos; Asuncion Moreno; Julian Torre-Cisneros; Jorge Carratalá Journal: Clin Infect Dis Date: 2008-10-01 Impact factor: 9.079