title: Cytomegalovirus infection after acute rejection therapy in seropositive kidney transplant recipients.
abstract: BACKGROUND
  Acute rejection (AR) after solid organ transplantation has been known to be a risk factor for cytomegalovirus (CMV) infection. However, data regarding the risk for CMV infection during and after anti-rejection therapy are limited. This study investigated whether the risk of CMV infection and disease within 6 months of kidney transplantation (KT) increases in CMV-seropositive KT recipients who develop AR.
  
  
  METHODS
  A total of 992 seropositive KT recipients, including 75 patients (8%) who developed AR within 6 months after KT and 917 patients (92%) who did not, were recruited between May 2007 and April 2012.
  
  
  RESULTS
  No significant difference was found in the incidence of CMV infection between the groups (AR group, 13% [10/75] vs. non-AR group, 10% [92/917], P = 0.37). The number of KT recipients in each group receiving preemptive therapy for CMV was similar (5% [4/75] vs. 6% [53/917], P > 0.99). While the incidence of CMV syndrome was comparable (0% [0/75] vs. 1% [12/917], P > 0.99), the incidence of tissue-invasive CMV disease (8% [6/75] vs. 3% [27/917], P = 0.04), particularly gastrointestinal CMV disease, was significantly greater in patients who experienced AR. No CMV-related mortality occurred in either group. AR (odds ratio, 2.81; 95% confidence interval, 1.08-7.29; P = 0.03) was an independent risk factor for tissue-invasive CMV disease within 6 months of KT.
  
  
  CONCLUSIONS
  A high index of suspicion and active evaluation for tissue-invasive CMV disease in KT recipients suffering AR may be necessary to ensure appropriate treatment.
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Department of Infectious Diseases, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
authors.forename: Y-M
authors.initials: YM
authors.lastname: Lee
authors.forename: Y H
authors.initials: YH
authors.lastname: Kim
authors.forename: D J
authors.initials: DJ
authors.lastname: Han
authors.forename: S-K
authors.initials: SK
authors.lastname: Park
authors.forename: J S
authors.initials: JS
authors.lastname: Park
authors.forename: H
authors.initials: H
authors.lastname: Sung
authors.forename: H-L
authors.initials: HL
authors.lastname: Hong
authors.forename: T
authors.initials: T
authors.lastname: Kim
authors.forename: S-H
authors.initials: SH
authors.lastname: Kim
authors.forename: S-H
authors.initials: SH
authors.lastname: Choi
authors.forename: Y S
authors.initials: YS
authors.lastname: Kim
authors.forename: J H
authors.initials: JH
authors.lastname: Woo
authors.forename: S-O
authors.initials: SO
authors.lastname: Lee
mesh_terms: D000328:Adult; D000375:Aging; D003587:Cytomegalovirus / Q000302:isolation & purification* / Q000502:physiology; D003586:Cytomegalovirus Infections / Q000209:etiology*; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D014775:Virus Activation; D014779:Virus Replication
chemical_list: D007166:Immunosuppressive Agents
keywords: acute rejection; cytomegalovirus infection; kidney transplantation