title: Risk factors for late-onset cytomegalovirus infection or disease in kidney transplant recipients.
abstract: BACKGROUND
  CMV-D+/R- serostatus is the only well-established risk factor for late-onset cytomegalovirus (CMV) infection/disease (i.e., incident CMV infection/disease after cessation of prophylactic antiviral therapy). This study aimed to explore other potential risk factors for late-onset CMV infection/disease in kidney transplant recipients.
  
  
  METHODS
  We conducted a retrospective cohort study of 641 kidney transplant recipients in Toronto, Canada, from January 1, 2003, to December 31, 2010. The cumulative incidence of late-onset CMV infection/disease was assessed using the Kaplan-Meier product-limit method. Potential risk factors for late-onset CMV infection/disease were examined using Cox proportional hazards regression models.
  
  
  RESULTS
  Cumulative incidence estimates for CMV infection/disease after prophylaxis cessation in D+/R- versus D+/R+ versus D-/R+ patients were 26.2% versus 7.4% versus 3.1% at 6 months and 30.0% versus 7.7% versus 3.7% at 1 year, respectively. D+/R- serostatus (vs. R+ serostatus) and an estimated glomerular filtration rate of less than 45 mL/min (vs. ≥ 60 mL/min) at prophylaxis cessation were independently associated with late-onset CMV infection/disease (hazard ratio, 4.04 [95% confidence interval, 2.39-6.83]; and hazard ratio, 2.03 [95% confidence interval, 1.07-3.88], respectively).
  
  
  CONCLUSIONS
  Patients with lower estimated glomerular filtration rate at prophylaxis cessation may be at an increased risk of late-onset CMV infection/disease and should be considered for more intensive CMV viral load monitoring, particularly within the first year after prophylaxis cessation.
authors.affiliation: 1 Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada. 2 Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 3 Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 4 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. 5 Address correspondence to: S. Joseph Kim, M.D., Ph.D., M.H.S., F.R.C.P.C., Toronto General Hospital, University Health Network, 585 University Ave., 11C-1183, Toronto, Ontario, Canada M5G 2N2.
authors.forename: Alainna J
authors.initials: AJ
authors.lastname: Jamal
authors.forename: Shahid
authors.initials: S
authors.lastname: Husain
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Li
authors.forename: Olusegun
authors.initials: O
authors.lastname: Famure
authors.forename: S Joseph
authors.initials: SJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003586:Cytomegalovirus Infections / Q000453:epidemiology* / Q000517:prevention & control*; D005260:Female; D015774:Ganciclovir / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014180:Transplantation; D000077562:Valganciclovir
chemical_list: D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir