Cytomegalovirus serologic matching in deceased donor kidney allocation optimizes high- and low-risk (D+R− and D−R−) profiles and does not adversely affect transplant rates

Abstract

is a major cause of morbidity and an occasional cause of mortality among kidney transplant recipients. Clinical consequences of CMV in immunosuppressed patients range from asymptomatic viremia to tissue invasive disease. Additionally, CMV has been associated with increased rates of bacterial and fungal infections, posttransplant lymphoproliferative disorder, rejection, allograft dysfunction and failure, cardiovascular complications, and new onset diabetes after transplant. 1,2 Despite significant improvements in diagnosis, prevention, and treatment of CMV over the past few decades, CMV infection and related complications continue to impose a major burden on kidney transplant recipients.

CMV high-risk status and posttransplant outcomes in kidney transplant recipients treated with belatacept

“…The combination of donor and recipient CMV status is already taken into account for kidney transplant allocation in some regions. Recently, Lockridge et al reported the outcomes following the implementation of a CMV‐matching policy for deceased donor allocation in Oregon and demonstrated a significant decrease in CMV viremia incidence 18 . In case of living donor transplant, a CMV negative donor could be preferred to a CMV positive one in the case of multiple donors if the recipient is seronegative, or in the event of a single donor participation in paired‐exchange program to allow allocation of a CMV negative donor could be considered.…”

The Clinical and Economic Benefit of CMV Matching in Kidney Transplant: A Decision Analysis

“…To mitigate the lingering CMV risk of the D+R– population and enhance the number of low-risk D–R– recipients, the 3 kidney transplant centers in the greater Oregon Donation Service Area (Oregon Health and Sciences University, Portland Veterans Administration, and Legacy Good Samaritan) implemented a novel CMV prevention strategy via matching deceased kidney donors and recipients by CMV serostatus. 16 In this pilot, kidneys from seropositive deceased donors were preferentially allocated to seropositive recipients, while organs from seronegative donors were allocated to seronegative recipients. Exceptions were made for patients with difficult-to-match high-panel reactive antibody (PRA) and medical urgency.…”

“…The methods of the CMV matching policy have been previously described and did not adversely affect transplant rates for identified at risk populations. 16 Also, CMV infection rates, cumulative duration of antiviral prophylaxis, and costs associated with antiviral prophylaxis and treatment improved dramatically after the policy change. 16…”

“…16 Also, CMV infection rates, cumulative duration of antiviral prophylaxis, and costs associated with antiviral prophylaxis and treatment improved dramatically after the policy change. 16…”

Risk assessment of human cytomegalovirus infection in solid organ transplantation: Insight into CD4+ T cell subsets

“…It has been considered a risk factor for allograft dysfunction and rejection. 1,2 HCMV infection or disease occurs according to the type of transplanted organ, immunosuppressive strategy, and host immune status. 3 Without preventive strategies, 40%-80% of transplant patients will develop HCMV infection.…”