title: Cytomegalovirus serostatus pairing and deceased donor kidney transplant outcomes in adult recipients with antiviral prophylaxis.
abstract: BACKGROUND
  The objectives of this study are to investigate the impact of cytomegalovirus (CMV) donor (D)/recipient (R) serostatus on kidney transplant outcomes in recipients who received CMV prophylaxis and to investigate the association of individual antiviral agents (acyclovir, ganciclovir, and valganciclovir) with outcomes in high-risk recipients (D+/R-).
  
  
  METHODS
  By using the Organ Procurement and Transplant Network/United Network for Organ Sharing database, 25,058 deceased donor kidney recipients (≥ 18 years, 2004-2008) who received CMV prophylaxis were stratified into four groups: D+/R+ (11,875), D-/R+ (6046), D+/R- (4555), and D-/R- (2582). The impact of CMV D/R serostatus on acute rejection (6 months and 1 year posttransplant) and long-term outcomes of death-censored graft failure and mortality were compared. The impact of the individual antiviral agent on long-term outcome was further evaluated in the high-risk group (D+/R-).
  
  
  RESULTS
  In multivariate analysis, CMV D/R status was not associated with acute rejection. Compared with D-/R-, D+/R- was associated with an increased risk for death-censored graft failure (hazard ratio=1.28, P=0.01), all-cause mortality(hazard ratio=1.36, P=0.003), and mortality because of viral infection (hazard ratio=8.36, P=0.04). In the D+/R- group, valganciclovir usage was associated with a decreased risk for death-censored graft failure (hazard ratio=0.65, P=0.007) and mortality because of viral infection (hazard ratio=0.22, P=0.03) compared with ganciclovir usage.
  
  
  CONCLUSIONS
  CMV mismatch (D+/R-) was no longer a risk factor for acute rejection in kidney recipients who received antiviral prophylaxis but was still an independent risk factor for death-censored graft failure, all-cause mortality, and viral infection-related mortality.
authors.affiliation: Division of Nephrology, Kidney and Pancreas Transplant Program, David Geffen School of Medicine at University of California, Los Angeles, CA, USA.
authors.forename: Hung-Tien
authors.initials: HT
authors.lastname: Kuo
authors.forename: Xiaoyi
authors.initials: X
authors.lastname: Ye
authors.forename: Marcelo Santos
authors.initials: MS
authors.lastname: Sampaio
authors.forename: Pavani
authors.initials: P
authors.lastname: Reddy
authors.forename: Suphamai
authors.initials: S
authors.lastname: Bunnapradist
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use*; D003587:Cytomegalovirus / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000276:immunology* / Q000517:prevention & control*; D016208:Databases, Factual; D005260:Female; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D006084:Graft Rejection / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D000077562:Valganciclovir; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir; D000212:Acyclovir