Cytomegalovirus serostatus pairing and deceased donor kidney transplant outcomes in adult recipients with antiviral prophylaxis.
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.
Kuo
Hung-Tien
HT
Division of Nephrology, Kidney and Pancreas Transplant Program, David Geffen School of Medicine at University of California, Los Angeles, CA, USA.
Ye
Xiaoyi
X
Sampaio
Marcelo Santos
MS
Reddy
Pavani
P
Bunnapradist
Suphamai
S
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
D000914:Antibodies, Viral; D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir; D000212:Acyclovir