title: Cytomegalovirus disease in African-American kidney transplant patients.
abstract: BACKGROUND
  Cytomegalovirus (CMV) disease is a serious infection after kidney transplantation. The risk factors and the impact of CMV disease in African-American (AA) kidney transplant patients have not been well characterized.
  
  
  METHODS
  We performed a retrospective analysis on 448 AA patients transplanted between 1996 and 2005. A 3-month universal chemoprophylaxis with ganciclovir or valganciclovir was administered to CMV donor-positive/recipient-negative (D+/R-) patients and to those treated with anti-thymocyte globulin for rejection, but not routinely to those with other D/R serostatus.
  
  
  RESULTS
  A total of 31 AA patients (7%) developed clinical CMV disease. Compared with other D/R serostatus groups, the D+/R- group had the highest 3-year cumulative incidence of CMV disease (16.9% vs. 6.3% in D+/R+, 4.9% in D-/R+, and 2.4% in D-/R-). The D+/R- group also had the worst 3-year death-censored allograft survival (75% vs. 92% in D+/R+, 94% in D-/R+, and 96% in D-/R-, log-rank P = 0.01). Multivariate analysis found that D+/R- serostatus (odds ratio [OR] 5.4, 95% confidence interval [CI] 0.6-48.2, P = 0.003) and donor age > 60 years (OR 9.1, 95% CI 1.3-65, P = 0.03) were independent risk factors for CMV disease.
  
  
  CONCLUSIONS
  The D+/R- group has the highest incidence of CMV disease and the worst 3-year renal allograft survival despite 3-month universal prophylaxis. Prolonged chemoprophylaxis may be needed to prevent the late development of CMV disease and to improve allograft survival in the high-risk group of AA kidney transplant recipients.
authors.affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
authors.forename: J
authors.initials: J
authors.lastname: McGee
authors.forename: V
authors.initials: V
authors.lastname: Mave
authors.forename: C L
authors.initials: CL
authors.lastname: Yau
authors.forename: M
authors.initials: M
authors.lastname: Killackey
authors.forename: A
authors.initials: A
authors.lastname: Paramesh
authors.forename: J
authors.initials: J
authors.lastname: Buell
authors.forename: D P
authors.initials: DP
authors.lastname: Slakey
authors.forename: L L
authors.initials: LL
authors.lastname: Hamm
authors.forename: R
authors.initials: R
authors.lastname: Zhang
mesh_terms: D000328:Adult; D001741:Black or African American; D000998:Antiviral Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D003586:Cytomegalovirus Infections / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents