Incidence and predictive factors for cytomegalovirus infection in renal transplant recipients.
BACKGROUND
Cytomegalovirus (CMV) infection is a common cause of morbidity, graft loss, and mortality among kidney recipients due to its direct and indirect influences on organs and systems, namely, immunomodulation, which favors the appearance of opportunistic infections, vasculopathy, and decreased graft and patient survival. In Mexico the dimensions of this infection are unknown in kidney transplant recipients. We evaluated the incidence and predictive factors for CMV infection among renal transplant recipients of the Mexican Institute of Social Security in Guadalajara.


METHODS
This prospective cohort analysis of patients >or=16 years of age of both genders, included transplantations from May 2006 to July 2007. Two hundred twenty-five patients were followed over 6 months to evaluate CMV infection or disease. We evaluated demographic, clinical, and paraclinical aspects, such as total lymphocyte count and quantitative CMV polymerase chain reactions (PCR).


RESULTS
The overall incidence of CMV infection was 17.8%. CMV infections were associated with lymphopenia (relative risk [RR] 14.75; confidence interval [CI] 95%, 3.46-62.77), serostatus D+/R- (RR 5.53; CI 95%, 2.18-14.05), and fever (RR 4.57; CI 95%, 1.50-13.95). Receiver-operating characteristic (ROC) curves for lymphopenia versus PCR showed a sensitivity of 27% and a specificity of 98%.


CONCLUSIONS
In our study, lymphopenia, serostatus D+/R-, and fever were good predictors of CMV infections among renal transplant recipients.
Corona-Nakamura
A L
AL
Infectious Disease Department, Specialities Hospital, West Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, México. anacoronan@yahoo.com.mx
Monteón-Ramos
F J
FJ
Troyo-Sanromán
R
R
Arias-Merino
M J
MJ
Anaya-Prado
R
R
D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003587:Cytomegalovirus / Q000235:genetics; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D005334:Fever / Q000821:virology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology; D018655:Lymphocyte Count; D008297:Male; D016133:Polymerase Chain Reaction; D011183:Postoperative Complications / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011336:Probability; D012372:ROC Curve; D012306:Risk; D055815:Young Adult
D000998:Antiviral Agents; D004279:DNA, Viral; D007166:Immunosuppressive Agents