Epidemiology of cytomegalovirus infection after pancreas transplantation

Ajay K. Parsaik, Tajinder Bhalla, Ming Dong, Nassir Rostambeigi, Ross A. Dierkhising, Patrick Dean, Roshini Abraham, Mikel Prieto, Walter K Kremers, Raymund R Razonable, Yogish C Kudva

Research output: Contribution to journalArticle

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Abstract

BACKGROUND.: Epidemiology of cytomegalovirus (CMV) infection has not been comprehensively studied after all three types of pancreas transplant (PT) including simultaneous pancreas-kidney transplantation (SPK), pancreas transplantation alone (PTA), and pancreas after kidney transplantation (PAK). METHODS.: We evaluated incidence, risk factors, and outcomes of CMV infection after pancreas transplant at our center from January 1, 1998, to December 31, 2009. RESULTS.: The study cohort included 252 recipients (SPK 60, PTA 71, and PAK 121), 53% men, age 43.9±9 years, followed for 6.3 (interquartile range 3-9) years. CMV serostatus was donor (D) seropositive and recipient (R) seronegative (D+/R-) (27%), D+/R+ (32%), D-/R+ (18%), D-/R- (23%), and one unknown/R+ (0.4%). Two hundred six (82%) patients received CMV prophylaxis. Twelve patients experienced CMV viremia, whereas 31 developed CMV disease. The cumulative incidence of CMV infection (viremia and disease) was 15%, 17%, and 20% at 1, 5, and 10 years, respectively, with no events after 10 years. It was higher in D+/R- group (P<0.004) and patients with kidney graft failure (P=0.036). The variables significantly associated with pancreas graft failure were transplant type (PTA vs. SPK, hazard ratio [HR]=2.29, P=0.020; PAK vs. SPK, HR=2.73, P=0.003) and acute pancreas rejection (HR=2.47, P<0.001). In multivariable mortality model, increased age (P<0.001) and pancreas graft failure (P<0.001) were associated with an increased risk of death, whereas CMV infection (P=0.036) was associated with a borderline decreased risk. CONCLUSIONS.: CMV remains a common cause of clinical illness, particularly among the CMV D+/R- mismatched and patients with kidney graft failure. Marginal association was observed between CMV infection and a lower risk of death, but not with allograft failure.

Original languageEnglish (US)
Pages (from-to)1044-1050
Number of pages7
JournalTransplantation
Volume92
Issue number9
DOIs
StatePublished - Nov 15 2011

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Pancreas Transplantation
Cytomegalovirus Infections
Pancreas
Kidney Transplantation
Epidemiology
Cytomegalovirus
Transplants
Viremia
Renal Insufficiency
Incidence
Allografts
Cohort Studies
Tissue Donors
Mortality

Keywords

  • Cytomegalovirus infection
  • Graft failure
  • Pancreas transplantation

ASJC Scopus subject areas

  • Transplantation

Cite this

Parsaik, A. K., Bhalla, T., Dong, M., Rostambeigi, N., Dierkhising, R. A., Dean, P., ... Kudva, Y. C. (2011). Epidemiology of cytomegalovirus infection after pancreas transplantation. Transplantation, 92(9), 1044-1050. https://doi.org/10.1097/TP.0b013e31823015c1

Epidemiology of cytomegalovirus infection after pancreas transplantation. / Parsaik, Ajay K.; Bhalla, Tajinder; Dong, Ming; Rostambeigi, Nassir; Dierkhising, Ross A.; Dean, Patrick; Abraham, Roshini; Prieto, Mikel; Kremers, Walter K; Razonable, Raymund R; Kudva, Yogish C.

In: Transplantation, Vol. 92, No. 9, 15.11.2011, p. 1044-1050.

Research output: Contribution to journalArticle

Parsaik, AK, Bhalla, T, Dong, M, Rostambeigi, N, Dierkhising, RA, Dean, P, Abraham, R, Prieto, M, Kremers, WK, Razonable, RR & Kudva, YC 2011, 'Epidemiology of cytomegalovirus infection after pancreas transplantation', Transplantation, vol. 92, no. 9, pp. 1044-1050. https://doi.org/10.1097/TP.0b013e31823015c1
Parsaik AK, Bhalla T, Dong M, Rostambeigi N, Dierkhising RA, Dean P et al. Epidemiology of cytomegalovirus infection after pancreas transplantation. Transplantation. 2011 Nov 15;92(9):1044-1050. https://doi.org/10.1097/TP.0b013e31823015c1
Parsaik, Ajay K. ; Bhalla, Tajinder ; Dong, Ming ; Rostambeigi, Nassir ; Dierkhising, Ross A. ; Dean, Patrick ; Abraham, Roshini ; Prieto, Mikel ; Kremers, Walter K ; Razonable, Raymund R ; Kudva, Yogish C. / Epidemiology of cytomegalovirus infection after pancreas transplantation. In: Transplantation. 2011 ; Vol. 92, No. 9. pp. 1044-1050.
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abstract = "BACKGROUND.: Epidemiology of cytomegalovirus (CMV) infection has not been comprehensively studied after all three types of pancreas transplant (PT) including simultaneous pancreas-kidney transplantation (SPK), pancreas transplantation alone (PTA), and pancreas after kidney transplantation (PAK). METHODS.: We evaluated incidence, risk factors, and outcomes of CMV infection after pancreas transplant at our center from January 1, 1998, to December 31, 2009. RESULTS.: The study cohort included 252 recipients (SPK 60, PTA 71, and PAK 121), 53{\%} men, age 43.9±9 years, followed for 6.3 (interquartile range 3-9) years. CMV serostatus was donor (D) seropositive and recipient (R) seronegative (D+/R-) (27{\%}), D+/R+ (32{\%}), D-/R+ (18{\%}), D-/R- (23{\%}), and one unknown/R+ (0.4{\%}). Two hundred six (82{\%}) patients received CMV prophylaxis. Twelve patients experienced CMV viremia, whereas 31 developed CMV disease. The cumulative incidence of CMV infection (viremia and disease) was 15{\%}, 17{\%}, and 20{\%} at 1, 5, and 10 years, respectively, with no events after 10 years. It was higher in D+/R- group (P<0.004) and patients with kidney graft failure (P=0.036). The variables significantly associated with pancreas graft failure were transplant type (PTA vs. SPK, hazard ratio [HR]=2.29, P=0.020; PAK vs. SPK, HR=2.73, P=0.003) and acute pancreas rejection (HR=2.47, P<0.001). In multivariable mortality model, increased age (P<0.001) and pancreas graft failure (P<0.001) were associated with an increased risk of death, whereas CMV infection (P=0.036) was associated with a borderline decreased risk. CONCLUSIONS.: CMV remains a common cause of clinical illness, particularly among the CMV D+/R- mismatched and patients with kidney graft failure. Marginal association was observed between CMV infection and a lower risk of death, but not with allograft failure.",
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AU - Parsaik, Ajay K.

AU - Bhalla, Tajinder

AU - Dong, Ming

AU - Rostambeigi, Nassir

AU - Dierkhising, Ross A.

AU - Dean, Patrick

AU - Abraham, Roshini

AU - Prieto, Mikel

AU - Kremers, Walter K

AU - Razonable, Raymund R

AU - Kudva, Yogish C

PY - 2011/11/15

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N2 - BACKGROUND.: Epidemiology of cytomegalovirus (CMV) infection has not been comprehensively studied after all three types of pancreas transplant (PT) including simultaneous pancreas-kidney transplantation (SPK), pancreas transplantation alone (PTA), and pancreas after kidney transplantation (PAK). METHODS.: We evaluated incidence, risk factors, and outcomes of CMV infection after pancreas transplant at our center from January 1, 1998, to December 31, 2009. RESULTS.: The study cohort included 252 recipients (SPK 60, PTA 71, and PAK 121), 53% men, age 43.9±9 years, followed for 6.3 (interquartile range 3-9) years. CMV serostatus was donor (D) seropositive and recipient (R) seronegative (D+/R-) (27%), D+/R+ (32%), D-/R+ (18%), D-/R- (23%), and one unknown/R+ (0.4%). Two hundred six (82%) patients received CMV prophylaxis. Twelve patients experienced CMV viremia, whereas 31 developed CMV disease. The cumulative incidence of CMV infection (viremia and disease) was 15%, 17%, and 20% at 1, 5, and 10 years, respectively, with no events after 10 years. It was higher in D+/R- group (P<0.004) and patients with kidney graft failure (P=0.036). The variables significantly associated with pancreas graft failure were transplant type (PTA vs. SPK, hazard ratio [HR]=2.29, P=0.020; PAK vs. SPK, HR=2.73, P=0.003) and acute pancreas rejection (HR=2.47, P<0.001). In multivariable mortality model, increased age (P<0.001) and pancreas graft failure (P<0.001) were associated with an increased risk of death, whereas CMV infection (P=0.036) was associated with a borderline decreased risk. CONCLUSIONS.: CMV remains a common cause of clinical illness, particularly among the CMV D+/R- mismatched and patients with kidney graft failure. Marginal association was observed between CMV infection and a lower risk of death, but not with allograft failure.

AB - BACKGROUND.: Epidemiology of cytomegalovirus (CMV) infection has not been comprehensively studied after all three types of pancreas transplant (PT) including simultaneous pancreas-kidney transplantation (SPK), pancreas transplantation alone (PTA), and pancreas after kidney transplantation (PAK). METHODS.: We evaluated incidence, risk factors, and outcomes of CMV infection after pancreas transplant at our center from January 1, 1998, to December 31, 2009. RESULTS.: The study cohort included 252 recipients (SPK 60, PTA 71, and PAK 121), 53% men, age 43.9±9 years, followed for 6.3 (interquartile range 3-9) years. CMV serostatus was donor (D) seropositive and recipient (R) seronegative (D+/R-) (27%), D+/R+ (32%), D-/R+ (18%), D-/R- (23%), and one unknown/R+ (0.4%). Two hundred six (82%) patients received CMV prophylaxis. Twelve patients experienced CMV viremia, whereas 31 developed CMV disease. The cumulative incidence of CMV infection (viremia and disease) was 15%, 17%, and 20% at 1, 5, and 10 years, respectively, with no events after 10 years. It was higher in D+/R- group (P<0.004) and patients with kidney graft failure (P=0.036). The variables significantly associated with pancreas graft failure were transplant type (PTA vs. SPK, hazard ratio [HR]=2.29, P=0.020; PAK vs. SPK, HR=2.73, P=0.003) and acute pancreas rejection (HR=2.47, P<0.001). In multivariable mortality model, increased age (P<0.001) and pancreas graft failure (P<0.001) were associated with an increased risk of death, whereas CMV infection (P=0.036) was associated with a borderline decreased risk. CONCLUSIONS.: CMV remains a common cause of clinical illness, particularly among the CMV D+/R- mismatched and patients with kidney graft failure. Marginal association was observed between CMV infection and a lower risk of death, but not with allograft failure.

KW - Cytomegalovirus infection

KW - Graft failure

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