title: Delayed-onset cytomegalovirus disease coded during hospital readmission after kidney transplantation.
abstract: BACKGROUND
  Use of prophylactic anti-CMV therapy for 3 to 6 months after kidney transplantation can result in delayed-onset CMV disease. We hypothesized that delayed-onset CMV disease (occurring >100 days posttransplant) occurs more commonly than early-onset CMV disease and that it is associated with death.
  
  
  METHODS
  We assembled a retrospective cohort of 15,848 adult kidney transplant recipients using 2004 to 2010 administrative data from the California and Florida Healthcare Cost and Utilization Project State Inpatient Databases. We identified demographic data, comorbidities, CMV disease coded during readmission, and inpatient death. We used multivariate Cox proportional hazards modeling to determine risk factors for delayed-onset CMV disease and inpatient death.
  
  
  RESULTS
  Delayed-onset CMV disease was identified in 4.0%, and early-onset CMV disease was identified in 1.2% of the kidney transplant recipients. Risk factors for delayed-onset CMV disease included previous transplant failure or rejection (HR 1.4) and residence in the lowest-income ZIP codes (HR 1.2). Inpatient death was associated with CMV disease occurring 101 to 365 days posttransplant (HR 1.5), CMV disease occurring greater than 365 days posttransplant (HR 2.1), increasing age (by decade: HR 1.5), nonwhite race (HR 1.2), residence in the lowest-income ZIP codes (HR 1.2), transplant failure or rejection (HR 3.2), previous solid organ transplant (HR 1.7), and several comorbidities.
  
  
  CONCLUSIONS
  These data showed that delayed-onset CMV disease occurred more commonly than early-onset CMV disease and that transplant failure or rejection is a risk factor for delayed-onset CMV disease. Further research should be done to determine if delayed-onset CMV disease is independently associated with death.
authors.affiliation: 1 Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO. 2 Renal Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO. 3 Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO. 4 Address correspondence to: Carlos A. Q. Santos, M.D., 660 S. Euclid Avenue, Campus Box 8051, St. Louis, MO, 63110.
authors.forename: Carlos A Q
authors.initials: CA
authors.lastname: Santos
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Brennan
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Fraser
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Olsen
mesh_terms: D000328:Adult; D000367:Age Factors; D002140:California / Q000453:epidemiology; D015897:Comorbidity; D003586:Cytomegalovirus Infections / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D005431:Florida / Q000453:epidemiology; D006084:Graft Rejection / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007182:Income; D038801:International Classification of Diseases; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission; D016016:Proportional Hazards Models; D044469:Racial Groups; D012111:Residence Characteristics; D012307:Risk Factors; D013997:Time Factors