title: Risk factors for late-onset cytomegalovirus disease in donor seropositive/recipient seronegative kidney transplant recipients who receive antiviral prophylaxis.
abstract: BACKGROUND
  Cytomegalovirus (CMV) disease occurs frequently after cessation of antiviral prophylaxis in CMV-seronegative kidney transplant recipients from seropositive donors (D+R-), and the risk factors are incompletely defined.
  
  
  METHODS
  We retrospectively assessed the incidence, clinical features, and risk factors for CMV disease in a cohort of D+R- kidney transplant recipients who received antiviral prophylaxis at a single US transplant center using descriptive statistics and Cox proportional hazards models.
  
  
  RESULTS
  CMV disease developed in 29 of 113 (26%) D+R- patients at a median of 185 days (interquartile range 116-231 days) post transplant, including CMV syndrome (66%) and tissue invasive disease (34%). The incidence of CMV disease was higher in patients who underwent re-transplantation (57% vs. 24%) and this factor was independently associated with a higher risk of CMV disease in multivariable analysis (hazard ratio, 4.02; 95% confidence interval, 1.3-13; P = 0.016). Other demographic and transplant variables were not independently associated with a risk of late-onset CMV disease.
  
  
  CONCLUSIONS
  Despite a comprehensive analysis of patient and transplant variables, only re-transplantation was identified as a risk factor for CMV disease in D+R- kidney transplant recipients who received antiviral prophylaxis, but had limited clinical predictive value. The development of novel laboratory markers to identify patients at greatest risk for CMV disease should be a priority for future studies.
authors.affiliation: Department of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Boudreault
authors.forename: H
authors.initials: H
authors.lastname: Xie
authors.forename: R M
authors.initials: RM
authors.lastname: Rakita
authors.forename: J D
authors.initials: JD
authors.lastname: Scott
authors.forename: C L
authors.initials: CL
authors.lastname: Davis
authors.forename: M
authors.initials: M
authors.lastname: Boeckh
authors.forename: A P
authors.initials: AP
authors.lastname: Limaye
mesh_terms: D000328:Adult; D000914:Antibodies, Viral / Q000097:blood*; D000998:Antiviral Agents / Q000627:therapeutic use*; D018890:Chemoprevention; D003587:Cytomegalovirus / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors
chemical_list: D000914:Antibodies, Viral; D000998:Antiviral Agents; D015774:Ganciclovir