There have been progressive and considerable improvements in the early management of kidney transplant recipients, including HLA matching, induction, maintenance immunosuppressive therapy, and infection prophylaxis, leading to lower incidences of acute rejection and infection, primarily, cytomegalovirus (CMV) infection. 1 The availability of a highly effective oral drug, valganciclovir, is perhaps the primary reason for the growing shift from preemptive therapy to universal CMV prophylaxis. 2 Yet, drug-related toxicities, late CMV infection after discontinuation of prophylaxis, and costs are critical concerns. 3 The intricate relationship between CMV infection and acute rejection, 4,5 as well as their negative influence on renal function and graft survival 6 are well known. A recent retrospective cohort study showed no difference in the incidence of CMV Abstract Introduction: The complex interaction between cytomegalovirus (CMV) infection and acute rejection after kidney transplantation is well recognized.Methods: This single center retrospective cohort analysis investigated the incidence and risk factors associated with CMV infection after treatment for acute rejection (tAR) in kidney transplant recipients receiving only CMV preemptive therapy. Of the 938 kidney transplants performed between 04/30/2014 and 04/30/2015 we identified 87 (9.3%) that were treated for acute rejection within the first year.Results: Most patients (64%) received rATG induction therapy followed by tacrolimus in combination with azathioprine (67%) or mycophenolate (33%) and corticosteroids.The incidence of CMV infection/disease after tAR was 47%, of which 73% occurred within 30 days. Using multivariable logistic regression analysis, eGFR at 1 month (OR = 0.98; 95% CI, 0.97-0.99; P = 0.007) and timing of tAR (OR = 0.98; 95% CI, 0.96-0.99; P = 0.021) were independently associated with CMV infection/disease after tAR.
Conclusion:In this cohort of kidney transplant recipients receiving tacrolimus-based immunosuppressive and preemptive CMV therapy, almost 50% developed CMV infection/disease after tARin the first year of transplantation. Early rejection and poor initial renal function were risk factors associated with CMV infection or disease.
K E Y W O R D Sacute rejection, cytomegalovirus, kidney transplant