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Cytomegalovirus infection after acute rejection therapy in seropositive kidney transplant recipients
Author(s) -
Lee Y.M.,
Kim Y.H.,
Han D.J.,
Park S.K.,
Park J.S.,
Sung H.,
Hong H.L.,
Kim T.,
Kim S.H.,
Choi S.H.,
Kim Y.S.,
Woo J.H.,
Lee S.O.
Publication year - 2014
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12227
Subject(s) - medicine , cytomegalovirus , odds ratio , incidence (geometry) , gastroenterology , confidence interval , transplantation , risk factor , kidney transplantation , cytomegalovirus infection , betaherpesvirinae , kidney disease , immunology , human cytomegalovirus , viral disease , virus , herpesviridae , physics , optics
Background Acute rejection ( AR ) after solid organ transplantation has been known to be a risk factor for cytomegalovirus ( CMV ) infection. However, data regarding the risk for CMV infection during and after anti‐rejection therapy are limited. This study investigated whether the risk of CMV infection and disease within 6 months of kidney transplantation ( KT ) increases in CMV ‐seropositive KT recipients who develop AR . Methods A total of 992 seropositive KT recipients, including 75 patients (8%) who developed AR within 6 months after KT and 917 patients (92%) who did not, were recruited between May 2007 and April 2012. Results No significant difference was found in the incidence of CMV infection between the groups ( AR group, 13% [10/75] vs. non‐ AR group, 10% [92/917], P = 0.37). The number of KT recipients in each group receiving preemptive therapy for CMV was similar (5% [4/75] vs. 6% [53/917], P > 0.99). While the incidence of CMV syndrome was comparable (0% [0/75] vs. 1% [12/917], P > 0.99), the incidence of tissue‐invasive CMV disease (8% [6/75] vs. 3% [27/917], P = 0.04), particularly gastrointestinal CMV disease, was significantly greater in patients who experienced AR . No CMV ‐related mortality occurred in either group. AR (odds ratio, 2.81; 95% confidence interval, 1.08–7.29; P = 0.03) was an independent risk factor for tissue‐invasive CMV disease within 6 months of KT . Conclusions A high index of suspicion and active evaluation for tissue‐invasive CMV disease in KT recipients suffering AR may be necessary to ensure appropriate treatment.