Margaret R Jorgenson1, Jillian L Descourouez1, Brianna Cardinale2, Beini Lyu3, Brad C Astor3, Neetika Garg4, Christopher M Saddler4, Jeannina A Smith4, Didier A Mandelbrot4. 1. Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, Wisconsin. 2. University of Wisconsin School of Pharmacy, Madison, Wisconsin. 3. Department of Medicine and Population Health Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin. 4. Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, Wisconsin.
Abstract
BACKGROUND: Cytomegalovirus (CMV) infection in kidney transplant recipients has been anecdotally observed with concomitant or subsequent opportunistic infections (OI), but this association has yet to be defined or quantified. METHODS: Patients who received a renal transplant between 1/1/2005 and 6/30/2014 and developed CMV infection were matched to controls in a ratio of 1:2 and the rates of opportunistic co-infection were calculated within pre-specified time frames (-30 days to +90 days and -30 days to +180 days). The primary outcome was composite OI rate, and secondary outcomes included time to OI and patient and graft outcomes. CMV-OI association rates were estimated via conditional logistic regression. RESULTS: There were 2405 patients who received a renal transplant during the study period; 394 cases of CMV infection were identified. These cases were matched to 783 controls for a total of 805 participants. OI occurred in 14 patients in the CMV case group (CMV+) and in 5 patients in the control group (CMV-) in the -30 to +90 day time period (3.55% vs 0.64%, OR = 5.60, 95% CI: 2.02-12.55). When considering 180-day follow-up, OI occurred in 17 CMV+ patients and 8 CMV- patients (4.3% vs 1%, OR = 4.25, 95% CI: 1.83-9.85). Mean time from CMV diagnosis to OI was 33 ± 64 days (median 7 days). Mortality was 3 times more likely in the group with concomitant OI (CMV+/OI+) as compared to a matched cohort of patients with CMV infection without OI (CMV+/OI-) (unadjusted HR 3.02, 1.64-5.55, Tables 6 and 7). Cumulative survival for CMV+/OI+ patients was significantly worse than CMV+/OI- patients (P < 0.01). CONCLUSIONS: CMV is associated with a significantly increased risk of co-infection with OI, particularly fungal infections. Clinical suspicion for concomitant OI should drive further workup after a CMV diagnosis. Future studies are needed to better define those patients at highest risk to elucidate subpopulations where the benefits of prophylaxis outweigh the potential risks associated with these therapies.
BACKGROUND:Cytomegalovirus (CMV) infection in kidney transplant recipients has been anecdotally observed with concomitant or subsequent opportunistic infections (OI), but this association has yet to be defined or quantified. METHODS:Patients who received a renal transplant between 1/1/2005 and 6/30/2014 and developed CMV infection were matched to controls in a ratio of 1:2 and the rates of opportunistic co-infection were calculated within pre-specified time frames (-30 days to +90 days and -30 days to +180 days). The primary outcome was composite OI rate, and secondary outcomes included time to OI and patient and graft outcomes. CMV-OI association rates were estimated via conditional logistic regression. RESULTS: There were 2405 patients who received a renal transplant during the study period; 394 cases of CMV infection were identified. These cases were matched to 783 controls for a total of 805 participants. OI occurred in 14 patients in the CMV case group (CMV+) and in 5 patients in the control group (CMV-) in the -30 to +90 day time period (3.55% vs 0.64%, OR = 5.60, 95% CI: 2.02-12.55). When considering 180-day follow-up, OI occurred in 17 CMV+ patients and 8 CMV- patients (4.3% vs 1%, OR = 4.25, 95% CI: 1.83-9.85). Mean time from CMV diagnosis to OI was 33 ± 64 days (median 7 days). Mortality was 3 times more likely in the group with concomitant OI (CMV+/OI+) as compared to a matched cohort of patients with CMV infection without OI (CMV+/OI-) (unadjusted HR 3.02, 1.64-5.55, Tables 6 and 7). Cumulative survival for CMV+/OI+ patients was significantly worse than CMV+/OI- patients (P < 0.01). CONCLUSIONS: CMV is associated with a significantly increased risk of co-infection with OI, particularly fungal infections. Clinical suspicion for concomitant OI should drive further workup after a CMV diagnosis. Future studies are needed to better define those patients at highest risk to elucidate subpopulations where the benefits of prophylaxis outweigh the potential risks associated with these therapies.
Authors: Margaret R Jorgenson; Jillian L Descourouez; Cynthia Wong; Jill R Strayer; Sandesh Parajuli; John P Rice; Robert R Redfield; Jeannina A Smith; Didier A Mandelbrot; Christopher M Saddler Journal: Transpl Infect Dis Date: 2021-03-15
Authors: Richard Ahn; Joanna Schaenman; Zachary Qian; Harry Pickering; Victoria Groysberg; Maura Rossetti; Megan Llamas; Alexander Hoffmann; David Gjertson; Mario Deng; Suphamai Bunnapradist; Elaine F Reed Journal: Front Immunol Date: 2021-11-15 Impact factor: 7.561
Authors: Isabel Rodríguez-Goncer; María Ruiz-Ruigómez; Francisco López-Medrano; Hernando Trujillo; Esther González; Natalia Polanco; Eduardo Gutiérrez; Rafael San Juan; Laura Corbella; Tamara Ruiz-Merlo; Patricia Parra; María Dolores Folgueira; Amado Andrés; José María Aguado; Mario Fernández-Ruiz Journal: Transpl Int Date: 2022-01-20 Impact factor: 3.782