Impact of current transplantation management on the development of cytomegalovirus disease after renal transplantation.

Abstract

BACKGROUND:

Current advances in transplantation practices may influence the development of cytomegalovirus (CMV) disease after renal transplantation.

METHODS:

From September 2003 through February 2005, 1470 renal transplant recipients (55 of whom were kidney-pancreas transplant recipients) were prospectively studied in the 16 transplant centers affiliated with the Spanish Network of Infection in Transplantation, with use of an ad hoc-designed online database. Univariate and multivariate analyses with logistic regression were performed to detect risk factors for CMV disease.

RESULTS:

A total of 105 episodes of CMV disease (37 with visceral involvement) developed in 99 (6.7%) of 1470 patients. Attributable mortality appeared in 1 (1.0%) of 105 cases. Multivariate analysis showed that, apart from CMV serological mismatch, presence of rejection episodes, and the use of antilymphocitic drugs, a simultaneous pancreas transplantation (odds ratio [OR], 3.7; 95% confidence interval [CI], 1.5-9), use of cyclosporine (OR, 1.7; 95% CI, 1.18-2.9), a donor >60 years of age (OR, 2.3; 95% CI, 1.5-3.7), and chronic graft malfunction (OR, 1.8; 95% CI, 1.14-2.9) were independently associated with CMV disease, whereas use of sirolimus had a protective effect (OR, 0.27; 95% CI, 0.1-0.78).

CONCLUSIONS:

Additional risk factors related to current transplantation practices influence the epidemiology of CMV after renal transplantation and should be taken into account in the design of prophylactic strategies in this population of kidney or kidney-pancreas recipients.

• Authors: Rafael San Juan, José Maria Aguado, Carlos Lumbreras, Jesus Fortun, Patricia Muñoz, Joan Gavalda, Francisco Lopez-Medrano, Miguel Montejo, German Bou, Marino Blanes, Antonio Ramos, Asuncion Moreno, Julian Torre-Cisneros, Jorge Carratalá, RESITRA Network of the Spanish Study Group of Infection in Transplantation
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 47 Issue 7 Pg. 875-82 (Oct 01 2008) ISSN: 1537-6591 [Electronic] United States
• PMID: 18752439 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Immunosuppressive Agents
• Sirolimus

Topics

• Cytomegalovirus Infections (prevention & control)
• Female
• Graft Rejection (prevention & control)
• Humans
• Immunosuppressive Agents (adverse effects, therapeutic use)
• Kidney Transplantation (adverse effects)
• Male
• Middle Aged
• Multivariate Analysis
• Odds Ratio
• Pancreas Transplantation (adverse effects)
• Prospective Studies
• Risk Factors
• Sirolimus (adverse effects, therapeutic use)
• Spain