title: Persistent cytomegalovirus infection in kidney allografts is associated with inferior graft function and survival.
abstract: The long-term effects of cytomegalovirus (CMV) infections on kidney allografts are unknown. We examined the impact of persistent intragraft CMV infection on long-term kidney allograft function and survival. CMV was diagnosed in 82/172 renal transplant recipients by antigenemia test and viral cultures. Biopsies from 48 of 82 patients taken after CMV infection and from 15 patients with no previous CMV infection detected were available for the immunohistochemical demonstration of CMV antigens and DNA hybridization in situ. Five-year follow-up data from these 63 patients were analysed. In 17 patients, CMV antigens and/or DNA persisted in the biopsy >2 months after the last positive finding in blood or urine. Patients with persistent intragraft CMV had reduced graft survival (P = 0.041) and Cox regression analysis showed persistent CMV as a risk factor for reduced graft survival (RR: 3.5). Recipients with persistent intragraft CMV had reduced creatinine clearance 1 and 2 years after transplantation (P = 0.007) and in multivariate logistic regression analyses including several potential pre- and posttransplant risk factors, persistent CMV was an independent risk factor for lower clearance at 1 and 2 years (OR: 4.4 and 4.9). Our novel findings show that persistent intragraft CMV infection was associated with reduced kidney allograft function and survival.
authors.affiliation: Department of Medicine, Division of Nephrology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. ilkka.helantera@helsinki.fi
authors.forename: Ilkka
authors.initials: I
authors.lastname: Helanterä
authors.forename: Petri
authors.initials: P
authors.lastname: Koskinen
authors.forename: Patrik
authors.initials: P
authors.lastname: Finne
authors.forename: Raisa
authors.initials: R
authors.lastname: Loginov
authors.forename: Lauri
authors.initials: L
authors.lastname: Kyllönen
authors.forename: Kaija
authors.initials: K
authors.lastname: Salmela
authors.forename: Carola
authors.initials: C
authors.lastname: Grönhagen-Riska
authors.forename: Irmeli
authors.initials: I
authors.lastname: Lautenschlager
mesh_terms: D000328:Adult; D001706:Biopsy; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000209:etiology; D004247:DNA / Q000737:chemistry; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000473:pathology / Q000502:physiology / Q000821:virology*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D009693:Nucleic Acid Hybridization; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012307:Risk Factors
chemical_list: D004247:DNA