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, 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

Abstract

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.

Figures

Figure 1
Figure 1
Kaplan-Meier analysis of (A) graft and (B) RTR survival according to CMV serostatus >1 year after transplantation. Tested with log-rank test.

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