Alainna J Jamal1, Shahid Husain, Yanhong Li, Olusegun Famure, S Joseph Kim. 1. 1 Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada. 2 Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 3 Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 4 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. 5 Address correspondence to: S. Joseph Kim, M.D., Ph.D., M.H.S., F.R.C.P.C., Toronto General Hospital, University Health Network, 585 University Ave., 11C-1183, Toronto, Ontario, Canada M5G 2N2.
Abstract
BACKGROUND: CMV-D+/R- serostatus is the only well-established risk factor for late-onset cytomegalovirus (CMV) infection/disease (i.e., incident CMV infection/disease after cessation of prophylactic antiviral therapy). This study aimed to explore other potential risk factors for late-onset CMV infection/disease in kidney transplant recipients. METHODS: We conducted a retrospective cohort study of 641 kidney transplant recipients in Toronto, Canada, from January 1, 2003, to December 31, 2010. The cumulative incidence of late-onset CMV infection/disease was assessed using the Kaplan-Meier product-limit method. Potential risk factors for late-onset CMV infection/disease were examined using Cox proportional hazards regression models. RESULTS: Cumulative incidence estimates for CMV infection/disease after prophylaxis cessation in D+/R- versus D+/R+ versus D-/R+ patients were 26.2% versus 7.4% versus 3.1% at 6 months and 30.0% versus 7.7% versus 3.7% at 1 year, respectively. D+/R- serostatus (vs. R+ serostatus) and an estimated glomerular filtration rate of less than 45 mL/min (vs. ≥ 60 mL/min) at prophylaxis cessation were independently associated with late-onset CMV infection/disease (hazard ratio, 4.04 [95% confidence interval, 2.39-6.83]; and hazard ratio, 2.03 [95% confidence interval, 1.07-3.88], respectively). CONCLUSIONS: Patients with lower estimated glomerular filtration rate at prophylaxis cessation may be at an increased risk of late-onset CMV infection/disease and should be considered for more intensive CMV viral load monitoring, particularly within the first year after prophylaxis cessation.
BACKGROUND: CMV-D+/R- serostatus is the only well-established risk factor for late-onset cytomegalovirus (CMV) infection/disease (i.e., incident CMV infection/disease after cessation of prophylactic antiviral therapy). This study aimed to explore other potential risk factors for late-onset CMV infection/disease in kidney transplant recipients. METHODS: We conducted a retrospective cohort study of 641 kidney transplant recipients in Toronto, Canada, from January 1, 2003, to December 31, 2010. The cumulative incidence of late-onset CMV infection/disease was assessed using the Kaplan-Meier product-limit method. Potential risk factors for late-onset CMV infection/disease were examined using Cox proportional hazards regression models. RESULTS: Cumulative incidence estimates for CMV infection/disease after prophylaxis cessation in D+/R- versus D+/R+ versus D-/R+ patients were 26.2% versus 7.4% versus 3.1% at 6 months and 30.0% versus 7.7% versus 3.7% at 1 year, respectively. D+/R- serostatus (vs. R+ serostatus) and an estimated glomerular filtration rate of less than 45 mL/min (vs. ≥ 60 mL/min) at prophylaxis cessation were independently associated with late-onset CMV infection/disease (hazard ratio, 4.04 [95% confidence interval, 2.39-6.83]; and hazard ratio, 2.03 [95% confidence interval, 1.07-3.88], respectively). CONCLUSIONS:Patients with lower estimated glomerular filtration rate at prophylaxis cessation may be at an increased risk of late-onset CMV infection/disease and should be considered for more intensive CMV viral load monitoring, particularly within the first year after prophylaxis cessation.
Authors: L Cunha; I Laranjinha; R Birne; C Jorge; T J Carvalho; A Lança; S Coelho; M Bruges; D Machado Journal: Int J Organ Transplant Med Date: 2010-02-01
Authors: Christian van Delden; Susanne Stampf; Hans H Hirsch; Oriol Manuel; Pascal Meylan; Alexia Cusini; Cédric Hirzel; Nina Khanna; Maja Weisser; Christian Garzoni; Katja Boggian; Christoph Berger; David Nadal; Michael Koller; Ramon Saccilotto; Nicolas J Mueller Journal: Clin Infect Dis Date: 2020-10-23 Impact factor: 9.079