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

doi: 10.1097/01.tp.0000438197.38413.f2
Clinical and Translational Research

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.

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.

The authors declare no funding or conflicts of interest.

E-mail: joseph.kim@uhn.ca

A.J.J., S.H., and S.J.K. participated in all stages of the project presented, including research design, data collection, data analysis, and preparation of the article. Y.L. participated in data analysis and preparation and review of the article. O.F. participated in research design, data collection, and preparation and review of the article.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

Received 15 April 2013. Revision requested 24 May 2013.

Accepted 15 September 2013.

Accepted January 7, 2014

© 2014 by Lippincott Williams & Wilkins