Tomas Reischig1,2, Martin Kacer1,2, Petra Hruba2,3, Pavel Jindra2,4, Ondrej Hes2,5, Daniel Lysak2,3, Mirko Bouda1,2, Ondrej Viklicky2,3,6. 1. Department of Internal Medicine I, Charles University Medical School and Teaching Hospital, Pilsen, Czech Republic. 2. Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic. 3. Transplant Laboratory, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. 4. Department of Hemato-oncology, Charles University Medical School and Teaching Hospital, Pilsen, Czech Republic. 5. Department of Pathology, Charles University Medical School and Teaching Hospital, Pilsen, Czech Republic. 6. Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Abstract
BACKGROUND: Asymptomatic cytomegalovirus (CMV) infection is associated with graft dysfunction and failure. However, no study assessed CMV viral load in terms of the risk for graft failure. METHODS: In a prospective cohort of kidney transplant recipients, we assessed the impact of CMV DNAemia on the overall graft survival and the incidence of moderate-to-severe interstitial fibrosis and tubular atrophy (IF/TA) in protocol biopsy at 36 months. CMV DNAemia was stratified by viral load in whole blood. RESULTS: A total of 180 patients transplanted from October 2003 through January 2011 were included and followed for 4 years; 87 (48%) patients received 3-month prophylaxis with valacyclovir and 45 (25%) with valganciclovir; 48 (27%) were managed by pre-emptive therapy. Within 12 months of transplantation, CMV DNAemia developed in 102 (57%) patients with 36 (20%) having a viral load of ≥2,000 copies/ml. Multivariate Cox analysis identified CMV DNAemia as an independent risk factor for graft loss (hazard ratio 3.42; P=0.020); however, after stratification by viral load, only CMV DNAemia ≥2,000 copies/ml (hazard ratio 7.62; P<0.001) remained significant. Both early-onset (<3 months; P=0.048) and late-onset (>3 months; P<0.001) CMV DNAemia ≥2,000 copies/ml were risk factors for graft loss. The incidence of moderate-to-severe IF/TA was not significantly influenced by CMV DNAemia. CONCLUSIONS: Kidney transplant recipients having CMV DNAemia with a higher viral load irrespective of the time to onset are at increased risk for graft loss.
BACKGROUND: Asymptomatic cytomegalovirus (CMV) infection is associated with graft dysfunction and failure. However, no study assessed CMV viral load in terms of the risk for graft failure. METHODS: In a prospective cohort of kidney transplant recipients, we assessed the impact of CMV DNAemia on the overall graft survival and the incidence of moderate-to-severe interstitial fibrosis and tubular atrophy (IF/TA) in protocol biopsy at 36 months. CMV DNAemia was stratified by viral load in whole blood. RESULTS: A total of 180 patients transplanted from October 2003 through January 2011 were included and followed for 4 years; 87 (48%) patients received 3-month prophylaxis with valacyclovir and 45 (25%) with valganciclovir; 48 (27%) were managed by pre-emptive therapy. Within 12 months of transplantation, CMV DNAemia developed in 102 (57%) patients with 36 (20%) having a viral load of ≥2,000 copies/ml. Multivariate Cox analysis identified CMV DNAemia as an independent risk factor for graft loss (hazard ratio 3.42; P=0.020); however, after stratification by viral load, only CMV DNAemia ≥2,000 copies/ml (hazard ratio 7.62; P<0.001) remained significant. Both early-onset (<3 months; P=0.048) and late-onset (>3 months; P<0.001) CMV DNAemia ≥2,000 copies/ml were risk factors for graft loss. The incidence of moderate-to-severe IF/TA was not significantly influenced by CMV DNAemia. CONCLUSIONS: Kidney transplant recipients having CMV DNAemia with a higher viral load irrespective of the time to onset are at increased risk for graft loss.
Authors: Tomas Reischig; Martin Kacer; Petra Hruba; Hana Hermanova; Ondrej Hes; Daniel Lysak; Stanislav Kormunda; Mirko Bouda Journal: BMC Infect Dis Date: 2018-11-15 Impact factor: 3.090
Authors: Ramandeep Singh; Hessel Peters-Sengers; Ester B M Remmerswaal; Unsal Yapici; Karlijn A M I van der Pant; Neelke C van der Weerd; Joris J T H Roelofs; René A W van Lier; Fréderike J Bemelman; Sandrine Florquin; Ineke J M Ten Berge Journal: Transpl Int Date: 2020-07-04 Impact factor: 3.782
Authors: Elena Rho; Bettina Näf; Thomas F Müller; Rudolf P Wüthrich; Thomas Schachter; Seraina von Moos Journal: Clin Transplant Date: 2021-10-28 Impact factor: 3.456