Cytomegalovirus Disease, Short-Term Cardiovascular Events and Graft Survival in a Cohort of Kidney Transplant Recipients With High CMV IgG Seroprevalence

Abstract

Introduction: Both cytomegalovirus (CMV) infection and CMV disease have been linked with several long-term indirect effects in kidney transplant recipients. Research questions: We conducted a retrospective study to assess the association between cytomegalovirus disease and risks of death, shortterm cardiovascular events and graft loss in a cohort of renal transplant recipients. Design: The associations between CMV disease and death and cardiovascular events were determined using Cox regression models, while the association between viral disease and graft loss risk was analyzed through a competing risks regression according to the Fine and Gray method. Death with a functioning graft was considered as a competing risk event. Results: A total of 865 consecutive renal transplant recipients were included. The prevalence of seropositive donor/seronegative recipient (D+/R-) group was 89.9% with the remaining patients classified as seropositive recipient (R+). After median follow-up time of 24.4 months, CMV disease was not a risk factor for all-causes mortality (HR = 1.75; 95% CI 0.94-3.25), early cardiovascular events (HR = 0.54; 95% CI 0.16-1.82) or graft loss (subhazard ratio [the HR adjusted for competing risk of death with functioning graft] = 0.99; 95% CI 0.53-1.84). Conclusions: In this cohort with high prevalence of CMV IgG antibodies, we found no association between cytomegalovirus disease and risk of death or graft loss. The relationship between CMV and cardiovascular disease remains to be unraveled and probably corresponds to a multifactorial phenomenon involving individual risk factors and the immune response to infection rather than the virus effect itself.

Epidemiology, management, and burden of cytomegalovirus in solid organ transplant recipients in selected countries outside of Europe and North America: A systematic review

“…Most studies on the rate of CMV disease in SOT recipients ( n = 21/23, 91.3%) reported an incidence ranging between 0% and 19.0%, with results uniformly distributed within the range 6–7,9,20,25,30–34,36,37,42–50 . Based on five studies, all conducted in kidney recipients, CMV disease occurred within 4–6 months posttransplantation 7,9,20,44,46 .…”

“…Most studies on the rate of CMV disease in SOT recipients (n = 21/23, 91.3%) reported an incidence ranging between 0% and 19.0%, with results uniformly distributed within the range. [6][7]9,20,25,[30][31][32][33][34]36,37,[42][43][44][45][46][47][48][49][50] Based on five studies, all conducted in kidney recipients, CMV disease occurred within 4-6 months posttransplantation. 7,9,20,44,46 According to Table 1, rates of CMV disease were consistent across the countries of interest except for China, 49 Colombia, 30 South Korea, 25 and Turkey, 47 where rates were lower.…”