TY - JOUR
T1 - Predictors of CMV Infection in CMV-Seropositive Kidney Transplant Recipients
T2 - Impact of Pretransplant CMV-Specific Humoral Immunity
AU - Kirisri, Similan
AU - Vongsakulyanon, Apirom
AU - Kantachuvesiri, Surasak
AU - Razonable, Raymund R.
AU - Bruminhent, Jackrapong
N1 - Publisher Copyright:
© 2021 The Author(s). Published by Oxford University Press on behalf of Infectious Diseases Society of America.
PY - 2021/6/1
Y1 - 2021/6/1
N2 - Background: Although cytomegalovirus (CMV)-seropositive solid organ transplant recipients have a relatively lower risk of CMV infection than CMV-seronegative recipients who receive allograft from CMV-seropositive donors, some patients remain at risk of CMV infection after transplant. We investigated the pretransplant CMV-specific humoral immunity (CHI) and other CMV infection predictors in CMV-seropositive kidney transplant (KT) recipients. Methods: This retrospective study was conducted on adult CMV-seropositive KT recipients during 2017 and 2018. The cumulative incidence of CMV infection was estimated using the Kaplan-Meier method. CHI, measured with an enzyme-linked fluorescent immunoassay and other predictors for CMV infection, was analyzed using Cox proportional hazards models. Results: Of the 340 CMV-seropositive KT recipients (37% female; mean ± SD age, 43 ± 11 years), 69% received deceased-donor allograft and 64% received induction therapy. During a mean follow-up of 14 months, the cumulative incidence of CMV infection was 14.8%. In multivariate analysis, low pretransplant CHI (defined as anti-CMV immunoglobulin [IgG] titer <20 AU/mL) was significantly associated with CMV infection (hazard ratio [HR], 2.98; 95% CI, 1.31-6.77; P =.009). Other significant predictors of CMV infection included older donor age (HR, 1.03; 95% CI, 1.01-1.06; P =.005), antithymocyte induction therapy (HR, 2.90; 95% CI, 1.09-7.74; P =.033), and prolonged cold ischemic time (HR, 1.06; 95% CI, 1.02-1.10; P =.002). Conclusions: A low pretransplant CHI is independently associated with post-transplant CMV infection in CMV-seropositive KT recipients. A quantitative anti-CMV IgG assay could potentially stratify CMV-seropositive patients at risk of CMV infection after KT.
AB - Background: Although cytomegalovirus (CMV)-seropositive solid organ transplant recipients have a relatively lower risk of CMV infection than CMV-seronegative recipients who receive allograft from CMV-seropositive donors, some patients remain at risk of CMV infection after transplant. We investigated the pretransplant CMV-specific humoral immunity (CHI) and other CMV infection predictors in CMV-seropositive kidney transplant (KT) recipients. Methods: This retrospective study was conducted on adult CMV-seropositive KT recipients during 2017 and 2018. The cumulative incidence of CMV infection was estimated using the Kaplan-Meier method. CHI, measured with an enzyme-linked fluorescent immunoassay and other predictors for CMV infection, was analyzed using Cox proportional hazards models. Results: Of the 340 CMV-seropositive KT recipients (37% female; mean ± SD age, 43 ± 11 years), 69% received deceased-donor allograft and 64% received induction therapy. During a mean follow-up of 14 months, the cumulative incidence of CMV infection was 14.8%. In multivariate analysis, low pretransplant CHI (defined as anti-CMV immunoglobulin [IgG] titer <20 AU/mL) was significantly associated with CMV infection (hazard ratio [HR], 2.98; 95% CI, 1.31-6.77; P =.009). Other significant predictors of CMV infection included older donor age (HR, 1.03; 95% CI, 1.01-1.06; P =.005), antithymocyte induction therapy (HR, 2.90; 95% CI, 1.09-7.74; P =.033), and prolonged cold ischemic time (HR, 1.06; 95% CI, 1.02-1.10; P =.002). Conclusions: A low pretransplant CHI is independently associated with post-transplant CMV infection in CMV-seropositive KT recipients. A quantitative anti-CMV IgG assay could potentially stratify CMV-seropositive patients at risk of CMV infection after KT.
KW - CMV infection
KW - anti-CMV immunoglobulin G titer
KW - humoral immunity
KW - kidney transplantation
KW - viral-specific immunity
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U2 - 10.1093/ofid/ofab199
DO - 10.1093/ofid/ofab199
M3 - Article
AN - SCOPUS:85107439691
SN - 2328-8957
VL - 8
JO - Open Forum Infectious Diseases
JF - Open Forum Infectious Diseases
IS - 6
M1 - ofab199
ER -