title: The impact of early cytomegalovirus infection after kidney transplantation on long-term graft and patient survival.
abstract: This prospective observational cohort study is an extension of a previous study reporting effects of cytomegalovirus (CMV) on graft and patient survival in 471 patients who underwent kidney transplantation between 1994 and 1997. CMV pp65 antigen was measured every 7-14 d during the first three months after transplantation, given as number of CMV pp65-positive cells per 10(5) leukocytes. A positive test was defined as CMV infection. None of the patients received CMV prophylaxis or preemptive treatment. During a median of 13.7 (7.1-14.9) yr, the number of death-censored graft losses was 118 (25%) and of patient deaths 224 (48%). CMV infection was an independent significant risk factor for mortality in multivariate analysis (HR = 1.453, 95% CI 1.033-2.045, p = 0.032), adjusting for patient and donor age, preemptive transplantation, HLA-DR and -AB mismatches, living donor, acute rejection during the first three months, donor-recipient CMV IgG antibody status and diabetic nephropathy. In univariate analysis, CMV infection was significantly associated with death-censored graft loss but the association was not significant in multivariate model. CMV infection early after kidney transplantation is a predictor of overall mortality but not of death-censored graft loss after a median observation period of 13.7 yr.
authors.affiliation: Department of Nephrology Ullevål, Oslo University Hospital, Oslo, Norway.
authors.forename: Yuliya V
authors.initials: YV
authors.lastname: Smedbråten
authors.forename: Solbjørg
authors.initials: S
authors.lastname: Sagedal
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Leivestad
authors.forename: Geir
authors.initials: G
authors.lastname: Mjøen
authors.forename: Kåre
authors.initials: K
authors.lastname: Osnes
authors.forename: Halvor
authors.initials: H
authors.lastname: Rollag
authors.forename: Anna V
authors.initials: AV
authors.lastname: Reisaeter
authors.forename: Aksel
authors.initials: A
authors.lastname: Foss
authors.forename: Ingrid
authors.initials: I
authors.lastname: Os
authors.forename: Anders
authors.initials: A
authors.lastname: Hartmann
mesh_terms: D000293:Adolescent; D000328:Adult; D003587:Cytomegalovirus / Q000472:pathogenicity; D003586:Cytomegalovirus Infections / Q000209:etiology / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality*; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010750:Phosphoproteins / Q000097:blood; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014763:Viral Matrix Proteins / Q000097:blood; D055815:Young Adult
chemical_list: D010750:Phosphoproteins; D014763:Viral Matrix Proteins; C065418:cytomegalovirus matrix protein 65kDa
keywords: cytomegalovirus infection; graft loss; mortality; renal transplantation