title: Impact of Cytomegalovirus on Long-term Mortality and Cancer Risk After Organ Transplantation.
abstract: BACKGROUND
  There is conflicting evidence of the effect of cytomegalovirus (CMV) infection on survival and the risk of cancer after transplantation.
  
  
  METHODS
  All recipients of kidney, liver, heart, and lung transplants in the United Kingdom between 1987 and 2007 with known CMV immunoglobulin G status were identified from the U.K. Transplant Registry. Based on the donor-recipient CMV status, recipients were grouped into: donor (D) negative recipient (R) negative (D- R-), D-R+, D + R+ and D + R-. Cancer data were obtained from the Office for National Statistics. The impact of CMV infection on survival and cancer incidence was assessed.
  
  
  RESULTS
  The 10-year posttransplant survival in D-R- recipients (73.6% [95%CI, 72.3, 74.9]) was significantly higher (P < 0.0001) than in other recipients (66.1% [65.3, 66.9]). Compared with the D- R- group, the risk-adjusted hazard of death within 10 years of transplantation for D+ R- group was 14% higher for kidney recipients (P = 0.0495), 13% higher for liver recipients (P = 0.16), 34% higher for heart recipients (P = 0.01), and 35% higher for lung recipients (P = 0.006). The proportion of recipients with a cardiovascular cause of death was higher (P = 0.03) among the recipients exposed to CMV (18%) as compared to the D- R- recipients (16%). The CMV status was not associated with an increased risk of cancer.
  
  
  CONCLUSIONS
  The results from this large study demonstrate that CMV is associated with a significantly increased long-term mortality in kidney and cardiothoracic transplant recipients and an increased risk of cardiovascular death but not of posttransplant cancer.
authors.affiliation: 1 National Health Service Blood and Transplant, Stoke Gifford, Bristol, United Kingdom. 2 University Department of Surgery, Addenbrooke's Hospital, Hills Road, Cambridge, United Kingdom. 3 Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, Merseyside, United Kingdom. 4 Clatterbridge Cancer Centre, Wirral, Merseyside, United Kingdom. 5 School of Cancer Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom. 6 University Hospitals Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Desai
authors.forename: Dave
authors.initials: D
authors.lastname: Collett
authors.forename: Christopher J E
authors.initials: CJ
authors.lastname: Watson
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Johnson
authors.forename: Paul
authors.initials: P
authors.lastname: Moss
authors.forename: James
authors.initials: J
authors.lastname: Neuberger
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D016377:Organ Transplantation / Q000009:adverse effects / Q000401:mortality*; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology