Purpose: Despite the use of antiviral prophylaxis with valacyclovir, cytomegalovirus infection (CMV) can still occur in seropositive kidney transplant recipients. In this study, we aimed to assess the incidence of CMV DNAemia and its risk factors in Moroccan transplant recipients. Patients and Methods: Sixty kidney recipients with positive cytomegalovirus serostatus, receiving post-transplant prophylaxis were enrolled between 2013 and 2017. In total, 455 plasma samples were collected and tested for CMV DNAemia using PCR-based Abbott RealTime assays. Results: The incidence of CMV infection in seropositive patients was 63%. In patients with quantifiable DNAemia, the duration of CMV infection was significantly shorter than in those with detectable DNAemia (141.5 ± 96.9 vs 294.1 ± 112.6 days, P < 0.001). During prophylactic treatment, 14 of 30 patients (47.0%) experienced active replication with quantifiable DNAemia, whereas none of eight patients with detectable DNAemia did (P = 0.017). Patients with symptomatic DNAemia were significantly younger than those without symptoms (28.8 ± 5.12 vs 38.1 ± 12.34 years, P = 0.007). The peak viral loads were significantly associated with viral disease (odds ratio: 3.39, 95% confidence interval: 1.21-9.53, P = 0.02). The duration of DNAemia (21.2 vs 13.4 days, P = 0.028) was significantly longer in symptomatic patients. Significantly higher rates of acute rejection were exclusively observed in recipients with disease (4/8, 50% vs 0/22, 0%, P = 0.003). Conclusion:Patients with high-level DNAemia were at an increased risk of progression to disease and acute rejection. Monitoring the viral load during the first year posttransplantation is essential, to support current preventive strategies.

Despite the use of antiviral prophylaxis, the active cytomegalovirus (CMV) replication is still occurred in the seropositive kidney recipients. The aim of this study was to assess the incidence of CMV reactivation and potential risk factors associated with CMV disease. Data of sixty kidney transplant recipients who had received CMV prophylaxis were obtained between 2013 and 2017. Quantitative nucleic acid amplification testing for CMV viraemia was assessed using Abbott RealTime Polymerase Chain Reaction (PCR). Among the seropositive recipients, cumulative incidence for reactivation was 63%. In patients with quantitative viraemia, the time of active replication was significantly lower compared to those with detectable viraemia (141.5, SD:96.9 vs 294.1, SD: 112.6 days, P inferior to 0.001). During prophylactic treatment, 46.7% of patients with quantifiable viraemia had experienced active replication and none among patients with detectable viraemia (P= 0.017). Importantly, symptomatic reactivation was significantly observed in the younger patients with higher peak viraemia compared to those with symptoms free (28.8, SD:5.12 vs. 38.1, SD: 12.34 years, P= 0.007) and 3.8, SD: 1.59 vs. 2.4, SD: 0. 79 log10IU/ml, P = 0.003, respectively). Furthermore, the median duration of viraemia (21.2, vs. 13.4 days, P= 0.028) and period of CMV therapy (24.3 vs 12.3 days, P inferior to 0.001) were significantly longer for this group. In addition, intercurrent infections (75% vs. 23%, P = 0.028 ) and acute rejection (50 % vs 0%, P = 0.003) were significantly more frequent in symptomatic reactivation group. In addition, peak viral load was a potential risk factor for development of symptomatic reactivation with odds ratio 3.39, 95%CI=1.21-9.53, P = 0.02). In conclusion, CMV reactivation remains serious problem for seropositive recipients who were expected to be on antiviral prophylaxis. Patients with high level of viraemia may be at an increased risk of progression to CMV disease and adverse outcomes.

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