Long-term impact of CMV infection on allografts and on patient survival in renal transplant patients with protocol biopsies.
Cytomegalovirus (CMV) infection is a frequent complication of early posttransplantation. This study examines its impact on chronic allograft changes, long-term graft loss, and patient survival. We studied 594 patients who had protocol biopsies at 6 wk, and 3 and 6 mo posttransplantation. Chronic allograft changes were evaluated according to the updated Banff classification [interstitial fibrosis/tubular atrophy (IF/TA), vascular and glomerular lesions]. Follow-up data were available for up to 10 yr. CMV infection was diagnosed in 153 of 594 patients (26%) in the first year after transplantation, mostly within the first 3 mo. Graft survival was reduced in patients with CMV (P = 0.03) as well as the combined allograft/patient survival (P = 0.008). Prevalence of IF/TA at 6 wk after transplantation was already threefold higher in patients who experienced CMV infection later on compared with patients without CMV (P = 0.005). In multivariate analyses, CMV viremia or disease was not a significant factor for graft loss or death. In conclusion, patients with CMV infection posttransplantation show more chronic allograft changes early on, even before CMV infection, and development of IF/TA is not more prevalent in patients with CMV. Our data do not support a significant role of CMV in patient and graft outcomes.
Division of Nephrology and Hypertension, University of Virginia Health System, Charlottesville, Virginia; ue2u@virginia.edu.
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U
Erdbrügger
Division of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany; and.
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Scheffner
Department of Laboratory Medicine and Pathology, University of Edmonton, Edmonton, Ontario, Canada.
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Mengel
Division of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany; and.
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Schwarz
Division of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany; and.
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Haller
Division of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany; and.
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Gwinner
D000328:Adult; D064591:Allografts; D001284:Atrophy; D001706:Biopsy; D016009:Chi-Square Distribution; D003586:Cytomegalovirus Infections / Q000209:etiology / Q000401:mortality / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D005355:Fibrosis; D005858:Germany / Q000453:epidemiology; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D007166:Immunosuppressive Agents
CMV; long-term allograft function; patient survival; protocol biopsies