The Contribution of Cytomegalovirus to Atherosclerotic Events after Kidney Transplantation

With improvements in management of acute rejection and allograft function over the past decades, short-term survival after solid-organ transplantation is excellent, and death with a functioning graft has become the outcome for the majority of solid-organ transplant recipients. Thus, there is a necessity to focus not only on interventions to maintain graft function, but also to address other posttransplantation complications contributing to death among transplant recipients. Chief among these concerns is posttransplantation atherosclerosis. Atherosclerosis resulting in cardiovascular events is now the major cause of death in long-term survivors of renal, cardiac, and hematopoietic stem cell transplantations [1–3]. In a cohort of 2202 adult kidney transplant recipients with >10year graft survival, cardiovascular disease (CVD) was the major cause of mortality, followed by malignancy and infection [4]. The cause of posttransplantation atherosclerosis is multifactorial. Risk factors resembling those for atherosclerosis in the general population include pretransplantation CVD, diabetes, hypertension, hyperlipidemia, tobacco use, obesity, and renal disease [1]. For transplant recipients, additional contributors include transplant-related medications such as steroids, transplant nephropathy, posttransplantation diabetes, and posttransplantation dyslipidemia. Thus, identifying comorbidities that influence the progression of CVD in transplant recipients might provide interventions to prolong survival and quality of life.