title: In Kidney Transplant Recipients With a Positive Virtual Crossmatch, High PRA was Associated With Lower Incidence of Viral Infections.
abstract: BACKGROUND
  There is little information on the incidence, risk factors, and outcomes associated with CMV and BK infections in sensitized patients.
  
  
  METHODS
  We examined 254 consecutive kidney transplant recipients with positive virtual crossmatch and negative flow crossmatch.
  
  
  RESULTS
  A total of 111 patients (43%) developed CMV disease or BK infection or nephropathy (BKVN). Specifically, 78 patients (30.7%) developed BK infection, 19 (7.5%) had BKVN, and 33 (12.9%) presented with CMV disease. Four patients (1.5%) developed both infections. Mean time from transplant to diagnosis for BK and CMV was 4.07 ± 3.10 and 8.35 ± 5.20 months, respectively. African American (HR, 2.64; 95% CI, 1.37-5.07; P = 0.003), thymoglobulin induction (HR, 2.18; 95% CI, 1.38-3.43; P = 0.0008), DSA greater than 500 MFI at transplant (HR, 1.64; 95% CI, 1.05-2.57; P = 0.03), history of diabetes (HR, 1.62; 95% CI, 1.01-2.60; P = 0.04), CMV D+/R- (HR, 2.30; 95% CI, 1.06-5.01; P = 0.03), and acute rejection (HR, 1.49; 95% CI, 0.99-2.24; P = 0.05) were associated with increase incident of BK/CMV, whereas rituximab (HR, 0.47; 95% CI, 0.24-0.91; P = 0.02), peak PRA greater than 80% (HR, 0.48; 95% CI, 0.27-0.84; P = 0.01), and living donor transplant (HR, 0.57; 95% CI, 0.36-0.87; P = 0.01) were associated with a lower likelihood of infection. Thymoglobulin induction (HR, 2.50; 95% CI, 1.02-6.13; P = 0.04), and peak PRA greater than 80% (HR, 0.45; 95% CI, 0.23-0.86; P = 0.02) remained significant predictors of infection after multivariate adjustment.
  
  
  CONCLUSIONS
  Although more than 40% of patients with a positive virtual crossmatch presented with BK infection/CMV disease, high PRA greater than 80% seemed to be protective.
authors.affiliation: 1 Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Sandesh
authors.initials: S
authors.lastname: Parajuli
authors.forename: Brenda L
authors.initials: BL
authors.lastname: Muth
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Turk
authors.forename: Brad C
authors.initials: BC
authors.lastname: Astor
authors.forename: Maha
authors.initials: M
authors.lastname: Mohammed
authors.forename: Didier A
authors.initials: DA
authors.lastname: Mandelbrot
authors.forename: Arjang
authors.initials: A
authors.lastname: Djamali
mesh_terms: D000328:Adult; D001739:BK Virus / Q000472:pathogenicity; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003586:Cytomegalovirus Infections / Q000097:blood / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control* / Q000821:virology; D016208:Databases, Factual; D005260:Female; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D027601:Polyomavirus Infections / Q000097:blood / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control* / Q000821:virology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D065840:Protective Factors; D012083:Renin / Q000097:blood*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014412:Tumor Virus Infections / Q000097:blood / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control* / Q000821:virology; D014922:Wisconsin / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D012083:Renin