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We studied the impact of a first post-transplant cytomegalovirus (CMV) infection greater than one year after primary kidney transplantation. Risk factors for developing late CMV were acute rejection and donor–recipient CMV status. Of those developing late CMV, 35% were donor (D) positive, recipient (R) negative; however, 23% were D+R+, 22% D−R+, and 15% D−R−. Late CMV was associated with significantly decreased patient and graft survival.

Nonadherence (NA) is a difficult posttransplant problem that can lead to graft loss. A retransplant for these recipients is controversial because of a fear of recurrent NA. We reviewed our center’s database and identified 119 recipients who lost their graft to overt NA; of this group, 38 (32%) underwent a retransplant after a thorough reevaluation. We compared this NA retransplant group to a control group of 2nd transplant recipients who did not lose their 1st graft to overt NA (n=728). After 8 years of follow-up, we found no differences between the 2 groups in actuarial graft or patient survival rates, renal function, or the incidence of biopsy-proven chronic rejection. However, 3 of 38 NA recipients vs. 9 of 728 2nd transplant recipients lost their retransplant to NA (p=0.03). We conclude that prior graft loss to NA is associated with increased graft loss to NA after retransplant; still, the majority of NA retransplant recipients did well – their overall long-term outcomes were similar to those of the 2nd transplant group. With careful patient selection and aggressive intervention, prior NA should not be an absolute contraindication to a retransplant.