Transplantation

Skip Navigation LinksHome > March 15, 2014 - Volume 97 - Issue 5 > Risk Factors for Late-Onset Cytomegalovirus Infection or Dis...
Transplantation:
doi: 10.1097/01.tp.0000438197.38413.f2
Clinical and Translational Research

Risk Factors for Late-Onset Cytomegalovirus Infection or Disease in Kidney Transplant Recipients

Jamal, Alainna J.1; Husain, Shahid1,2; Li, Yanhong1; Famure, Olusegun1,3; Kim, S. Joseph1,3,4,5

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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.

© 2014 by Lippincott Williams & Wilkins

 

 

 

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