HLA-DQ3 is a probable risk factor for CMV infection in high-risk kidney transplant patients.

Abstract

BACKGROUND:

Cytomegalovirus (CMV) infection in transplant patients with special risk factors remains a major hazard. CMV-seronegative recipients with seropositive donors have the highest risk of developing acute CMV disease. We suggest that the HLA-type may influence the occurrence and the severity of primary CMV infection of these recipients and the measurement of the special HLA-types may be useful in the prediction of acute infection.

METHODS:

Since 1999 1213 cadaver kidney transplantations have been performed in our clinic. 163 of 1213 recipients were CMV-seronegative (13%) and 129 of them received the kidney from seropositive donors. All 129 patients received CMV infection prophylaxis. Of 129 CMV-seronegative patients 49 developed acute CMV infection (38%) during the first posttransplant year. CMV infection was diagnosed by CMV antigenemia test and serologic measurements (ELISA). The particular HLA-genotypes of the recipients were studied before the transplantation. The occurrence and the severity of CMV infection was investigated in association with HLA-types.

RESULTS:

We found different acute CMV infection distribution in the careers and non-careers of investigated HLA-types: HLA-A2, HLA-B12, HLA-Cw7, HLA-DR6 and HLA-DR11, but the differences were not significant in these HLA-types (P = 0.26, P = 0.37, P = 0.83, P = 0.07 and P = 0.37). While investigating HLA-DQ3, we found that of 68 DQ3-positive patients 32 (47%), of 61 DQ3-negative patients 17 (28%) had acute CMV infection and this difference was found to be significant. This result was confirmed by univariate and multivariate Cox Regression (P = 0.001) and the appropriate significance level was considered by Bonferroni correction.

CONCLUSIONS:

HLA-DQ3 was found to be an independent predictor of CMV infection. Our data suggest that patients positive for HLA-DQ3 are more susceptible to CMV infection than a comparable group of patients negative for HLA-DQ3. This result was not due to rejection and/or treatment for rejection and was not influenced by induction therapy. Although we found more symptomatic infections among DQ3+ patients the difference was not significant (P = 0.19). Comparing the gender proportion among all 1213 kidney recipients and among CMV-seronegative recipients we found that the proportion of males is significantly higher among CMV-seronegative recipients (P < 0.001).

• Authors: Marina Varga, Katalin Rajczy, Gábor Telkes, Márta Hídvégi, Antal Péter, Adám Remport, Márta Korbonits, János Fazakas, Eva Toronyi, Enikõ Sárváry, László Kóbori, Jenõ Járay
• Journal: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association (Nephrol Dial Transplant) Vol. 23 Issue 8 Pg. 2673-8 (Aug 2008) ISSN: 1460-2385 [Electronic] England
• PMID: 18332066 (Publication Type: Journal Article)

Chemical References

• HLA-DQ Antigens
• HLA-DQ3 antigen

Topics

• Adolescent
• Adult
• Aged
• Child
• Child, Preschool
• Cytomegalovirus Infections (etiology, immunology, prevention & control, transmission)
• Female
• Genetic Predisposition to Disease
• Graft Rejection (etiology, immunology)
• HLA-DQ Antigens (genetics, metabolism)
• Histocompatibility Testing
• Humans
• Kidney Transplantation (adverse effects, immunology)
• Male
• Middle Aged
• Retrospective Studies
• Risk Factors
• Tissue Donors
• Young Adult