Impact of current transplantation management on the development of cytomegalovirus disease after renal transplantation.
BACKGROUND
Current advances in transplantation practices may influence the development of cytomegalovirus (CMV) disease after renal transplantation.


METHODS
From September 2003 through February 2005, 1470 renal transplant recipients (55 of whom were kidney-pancreas transplant recipients) were prospectively studied in the 16 transplant centers affiliated with the Spanish Network of Infection in Transplantation, with use of an ad hoc-designed online database. Univariate and multivariate analyses with logistic regression were performed to detect risk factors for CMV disease.


RESULTS
A total of 105 episodes of CMV disease (37 with visceral involvement) developed in 99 (6.7%) of 1470 patients. Attributable mortality appeared in 1 (1.0%) of 105 cases. Multivariate analysis showed that, apart from CMV serological mismatch, presence of rejection episodes, and the use of antilymphocitic drugs, a simultaneous pancreas transplantation (odds ratio [OR], 3.7; 95% confidence interval [CI], 1.5-9), use of cyclosporine (OR, 1.7; 95% CI, 1.18-2.9), a donor >60 years of age (OR, 2.3; 95% CI, 1.5-3.7), and chronic graft malfunction (OR, 1.8; 95% CI, 1.14-2.9) were independently associated with CMV disease, whereas use of sirolimus had a protective effect (OR, 0.27; 95% CI, 0.1-0.78).


CONCLUSIONS
Additional risk factors related to current transplantation practices influence the epidemiology of CMV after renal transplantation and should be taken into account in the design of prophylactic strategies in this population of kidney or kidney-pancreas recipients.
San Juan
Rafael
R
Unit of Infectious Diseases, University Hospital 12 de Octubre, Madrid, Spain. rafasjg@yahoo.es
Aguado
José Maria
JM
Lumbreras
Carlos
C
Fortun
Jesus
J
Muñoz
Patricia
P
Gavalda
Joan
J
Lopez-Medrano
Francisco
F
Montejo
Miguel
M
Bou
German
G
Blanes
Marino
M
Ramos
Antonio
A
Moreno
Asuncion
A
Torre-Cisneros
Julian
J
Carratalá
Jorge
J