Latent cytomegalovirus infection is an independent risk factor for late graft failure in renal transplant recipients
Rutger M. van Ree, Aiko P.J. de Vries, Dorien M. Zelle, Laura V. de Vries, Leendert H. Oterdoom, Reinold O.B. Gans, Jan P. Schouten, Simon P.M. Lems, Willem J. van Son, Stephan J.L. Bakker
Med Sci Monit 2011; 17(11): CR609-617
Background: Cytomegalovirus (CMV) is a risk factor for rejection and mortality soon after renal transplantation. Little is known about its consequences longer after transplantation. We prospectively investigated whether latent CMV infection is a risk factor for graft failure and mortality long after transplantation.
Material/Methods: Our study included 606 renal transplant recipients (RTR) with a functioning graft for >1 year. CMV serology was determined using ELISA. RTRs were divided into CMV-seronegative and latent CMV (seropositive + seroconverted).
Results: We measured CMV IgG at 6.0 [2.6–11.4] years post-transplant. During follow-up (7.0 [6.2–7.5] years), 54 (9%) RTRs experienced graft failure and 137 (23%) RTRs died. Risk for graft failure and mortality was significantly higher in RTRs with latent CMV compared to CMV-seronegative RTRs (HR=3.1, P=0.005 and HR=2.0, P=0.002, respectively). After adjustment for potential confounders, latent CMV infection remained an independent risk factor for graft failure (HR=4.6, P=0.001), but not for mortality (HR=1.4, P=0.2).
Conclusions: Latent CMV is an independent risk factor for graft failure long after renal transplantation and carries a higher risk for graft failure than for mortality. These findings confirm the notion that latent CMV can be harmful in transplanted kidneys.
Keywords: Prospective Studies, Linear Models, Kidney Transplantation - adverse effects, Immunoglobulin G - blood, Graft Rejection - virology, Enzyme-Linked Immunosorbent Assay, Cytomegalovirus Infections - epidemiology, Cohort Studies, Risk Factors, Statistics, Nonparametric