Latent cytomegalovirus infection is an independent risk factor for late graft failure in renal transplant recipients.
BACKGROUND
Cytomegalovirus (CMV) is a risk factor for rejection and mortality soon after renal transplantation. Little is known about its consequences longer after transplantation. We prospectively investigated whether latent CMV infection is a risk factor for graft failure and mortality long after transplantation.


METHODS
Our study included 606 renal transplant recipients (RTR) with a functioning graft for >1 year. CMV serology was determined using ELISA. RTRs were divided into CMV-seronegative and latent CMV (seropositive + seroconverted).


RESULTS
We measured CMV IgG at 6.0 [2.6-11.4] years post-transplant. During follow-up (7.0 [6.2-7.5] years), 54 (9%) RTRs experienced graft failure and 137 (23%) RTRs died. Risk for graft failure and mortality was significantly higher in RTRs with latent CMV compared to CMV-seronegative RTRs (HR=3.1, P=0.005 and HR=2.0, P=0.002, respectively). After adjustment for potential confounders, latent CMV infection remained an independent risk factor for graft failure (HR=4.6, P=0.001), but not for mortality (HR=1.4, P=0.2).


CONCLUSIONS
Latent CMV is an independent risk factor for graft failure long after renal transplantation and carries a higher risk for graft failure than for mortality. These findings confirm the notion that latent CMV can be harmful in transplanted kidneys.
Renal Transplant Program, University Medical Center Groningen and University of Groningen, The Netherlands.
Rutger M
RM
van Ree
Aiko P J
AP
de Vries
Dorien M
DM
Zelle
Laura V
LV
de Vries
Leendert H
LH
Oterdoom
Reinold O B
RO
Gans
Jan P
JP
Schouten
Simon P M
SP
Lems
Willem J
WJ
van Son
Stephan J L
SJ
Bakker
D015331:Cohort Studies; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000453:epidemiology*; D004797:Enzyme-Linked Immunosorbent Assay; D006084:Graft Rejection / Q000453:epidemiology* / Q000821:virology*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D016030:Kidney Transplantation / Q000009:adverse effects*; D016014:Linear Models; D011446:Prospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric
D007074:Immunoglobulin G