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Simultaneous pancreas/kidney transplant recipients are predisposed to tissue‐invasive cytomegalovirus disease and concomitant infectious complications
Author(s) -
Schachtner Thomas,
Zaks Marina,
Otto Natalie M.,
Kahl Andreas,
Reinke Petra
Publication year - 2017
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.12742
Subject(s) - medicine , viremia , concomitant , cytomegalovirus , serostatus , immunology , gastroenterology , incidence (geometry) , viral load , virus , herpesviridae , viral disease , physics , optics
Background Infections have increased in simultaneous pancreas/kidney transplant recipients ( SPKTR s) with cytomegalovirus ( CMV ) infection being the most important viral infection with adverse impact on patient and allograft outcomes. Methods We studied all primary SPKTR s and deceased‐donor kidney transplant recipients ( KTR s) between 2008 and 2015 for the development of CMV infection. A total of 21/62 SPKTR s (33.9%) and 90/335 KTR s (26.9%) were diagnosed with CMV infection. A control group of 41 SPKTR s without CMV infection was used for comparison. Results SPKTR s showed an increased incidence of CMV infection compared with KTR s. SPKTR s were more likely to develop CMV disease, CMV pneumonia, recurrent CMV infection, higher initial and peak CMV loads, and more need for intravenous antiviral therapy compared with KTR s ( P <.05). High‐risk CMV serostatus (D+R−) and 2 HLA ‐B/‐ DR mismatches increased the risk of CMV infection in SPKTR s ( P <.05). No differences were observed for patient and allograft outcomes ( P >.05). SPKTR s with CMV infection were more likely to show concomitant Epstein‐Barr virus ( EBV ) viremia compared with SPKTR s without CMV infection ( P <.05). SPKTR s with CMV infection showed higher incidences of concomitant BK polyomavirus‐associated nephropathy, EBV viremia, and sepsis compared with KTR s with CMV infection ( P <.05). Conclusion Our results suggest a higher incidence and more severe course of CMV infection in SPKTR s compared with KTR s. The increased incidence of concomitant infectious complications among SPKTR s with CMV infection suggests an overall impaired immunity, and calls for more intense screening.