title: Epidemiology of cytomegalovirus infection after pancreas transplantation.
abstract: BACKGROUND
  Epidemiology of cytomegalovirus (CMV) infection has not been comprehensively studied after all three types of pancreas transplant (PT) including simultaneous pancreas-kidney transplantation (SPK), pancreas transplantation alone (PTA), and pancreas after kidney transplantation (PAK).
  
  
  METHODS
  We evaluated incidence, risk factors, and outcomes of CMV infection after pancreas transplant at our center from January 1, 1998, to December 31, 2009.
  
  
  RESULTS
  The study cohort included 252 recipients (SPK 60, PTA 71, and PAK 121), 53% men, age 43.9±9 years, followed for 6.3 (interquartile range 3-9) years. CMV serostatus was donor (D) seropositive and recipient (R) seronegative (D+/R-) (27%), D+/R+ (32%), D-/R+ (18%), D-/R- (23%), and one unknown/R+ (0.4%). Two hundred six (82%) patients received CMV prophylaxis. Twelve patients experienced CMV viremia, whereas 31 developed CMV disease. The cumulative incidence of CMV infection (viremia and disease) was 15%, 17%, and 20% at 1, 5, and 10 years, respectively, with no events after 10 years. It was higher in D+/R- group (P<0.004) and patients with kidney graft failure (P=0.036). The variables significantly associated with pancreas graft failure were transplant type (PTA vs. SPK, hazard ratio [HR]=2.29, P=0.020; PAK vs. SPK, HR=2.73, P=0.003) and acute pancreas rejection (HR=2.47, P<0.001). In multivariable mortality model, increased age (P<0.001) and pancreas graft failure (P<0.001) were associated with an increased risk of death, whereas CMV infection (P=0.036) was associated with a borderline decreased risk.
  
  
  CONCLUSIONS
  CMV remains a common cause of clinical illness, particularly among the CMV D+/R- mismatched and patients with kidney graft failure. Marginal association was observed between CMV infection and a lower risk of death, but not with allograft failure.
authors: Division of Endocrinology, Diabetes, Nutrition, and Metabolism, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors: Ajay K
authors: AK
authors: Parsaik
authors: Tajinder
authors: T
authors: Bhalla
authors: Ming
authors: M
authors: Dong
authors: Nassir
authors: N
authors: Rostambeigi
authors: Ross A
authors: RA
authors: Dierkhising
authors: Patrick
authors: P
authors: Dean
authors: Roshini
authors: R
authors: Abraham
authors: Mikel
authors: M
authors: Prieto
authors: Walter K
authors: WK
authors: Kremers
authors: Raymund R
authors: RR
authors: Razonable
authors: Yogish C
authors: YC
authors: Kudva
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003586:Cytomegalovirus Infections / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000453:epidemiology* / Q000517:prevention & control; D016035:Pancreas Transplantation / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014766:Viremia / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents