title: Prevalence and clinical impact of cytomegalovirus infection and disease in renal transplantation: ten years of experience in a single center.
abstract: BACKGROUND
  Renal transplantation is regarded as the optimal treatment for patients with end-stage renal disease. Despite significant improvements in surgical techniques and immunosuppressive therapy, long-term graft survival has not markedly increased over the years, due in part to the occurrence of cytomegalovirus (CMV) infection.
  
  
  METHODS
  Between January 2001 and September 2011, we performed 592 kidney transplantations (214 living and 378 cadaveric donors). All patients received induction therapy with interleukin (IL)-2 monoclonal antibodies or antithymoglobulin (ATG) combined with calcineurin inhibitors, mycophenolate mofetil, or mTOR antagonists and steroids. All CMV-seronegative patients and all subjects receiving ATG induction were prescribed prophylactic therapy with ganciclovir-intravenous (IV) for 15 days 2.5 mg/kg BW bid and thereafter oral valgancyclovir once a day. CMV infection was diagnosed using a CMV-PVR of ≥ 600 copies. We analyzed the time to manifestations of CMV infection, or positive CMV-PCR, patient and graft survival, serum creatinine (Cr), and blood urea nitrogen (BUN) values before and after CMV infection, as well as type of immunosuppression therapy.
  
  
  RESULTS
  The overall incidences of CMV infection and CMV disease were 76/592 (12.8%) and 23/592 (3.9%), respectively. The mean ± standard deviation (SD) times to positive CMV-PCR and CMV disease were 16.66 ± 23.38 months and 106 ± 61.2 (range, 28-215) days, respectively. Mortality was 1% (6/592) among our whole population, 7.9% (6/76) for CMV-infected, and 26% (6/23) in the CMV disease cohort. Cr and BUN showed no significant differences among the groups.
  
  
  CONCLUSIONS
  CMV infection and CMV disease comprise significant clinical problems, increasing morbidity and mortality. The use of prophylactic anti-CMV treatment is of paramount importance.
authors.affiliation: Division of Transplantation, Department of Surgery, Medical School, Aristotle University and Hippokration General Hospital, Thessaloniki, Greece. dgiak@auth.gr
authors.forename: D
authors.initials: D
authors.lastname: Giakoustidis
authors.forename: A
authors.initials: A
authors.lastname: Antoniadis
authors.forename: I
authors.initials: I
authors.lastname: Fouzas
authors.forename: A
authors.initials: A
authors.lastname: Sklavos
authors.forename: A
authors.initials: A
authors.lastname: Giakoustidis
authors.forename: N
authors.initials: N
authors.lastname: Ouzounidis
authors.forename: D
authors.initials: D
authors.lastname: Gakis
authors.forename: K
authors.initials: K
authors.lastname: Koubanagiti
authors.forename: G
authors.initials: G
authors.lastname: Myserlis
authors.forename: A
authors.initials: A
authors.lastname: Tsitlakidis
authors.forename: I
authors.initials: I
authors.lastname: Gerogiannis
authors.forename: A
authors.initials: A
authors.lastname: Papagiannis
authors.forename: P
authors.initials: P
authors.lastname: Christoforou
authors.forename: T
authors.initials: T
authors.lastname: Deligiannidis
authors.forename: F
authors.initials: F
authors.lastname: Solonaki
authors.forename: G
authors.initials: G
authors.lastname: Imvrios
authors.forename: V
authors.initials: V
authors.lastname: Papanikolaou
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage; D015415:Biomarkers / Q000097:blood; D001806:Blood Urea Nitrogen; D003404:Creatinine / Q000097:blood; D003587:Cytomegalovirus / Q000235:genetics; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage / Q000031:analogs & derivatives; D006085:Graft Survival; D006115:Greece / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology / Q000401:mortality; D016014:Linear Models; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D000077562:Valganciclovir; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers; D007166:Immunosuppressive Agents; D003404:Creatinine; D000077562:Valganciclovir; D015774:Ganciclovir