We studied 594 patients who had a protocol biopsy (pBx) at 6 weeks, 3 and 6 months post transplant. Chronic allograft changes were evaluated according to the updated Banff classification (cGrade, cv, cg lesions). CMV infection was diagnosed by CMV antigenemia test. Follow up data was available up to 10 years.
CMV infection was diagnosed in 153 of 594 patients (26%) in the first year after transplantation, mostly within the first 3 months. In patients with CMV infection between the pBx at 6 weeks and 6 months, 11.5% of the biopsies had a positive cGrade at 6 weeks compared to 3.5% in patients without CMV (p=0.005). At 6 months, the prevalence of a cGrade greater 0 rose to 40.6% in patients with CMV and to 34.2% in the group without CMV (p=0.24). In patients with CMV infection early on within the first 6 weeks post-transplantation, 13% of the biopsies had a positive cGrade at 6 weeks compared to 3.5% in patients without CMV (p=0.06). At 6 months, the prevalence of a positive cGrade rose to 55% in patients with CMV and 34% in the group without CMV (p=0.09). Chronic vascular and glomerular changes were rarely seen in the protocol biopsies and were not different.
The annual loss of GFR was greater in patients with CMV infection (median: 3.6 vs 2.4ml/min per year, p=0.017). Allograft survival was reduced in patients with CMV (p=0.03) as well as the combined allograft/patient survival (p=0.008). Clinical and laboratory factors that differed between patients with and without CMV were recipient and donor age, pre-Tx coronary heart disease, CMV donor/recipient IgG serostatus, and initial graft function. Of these variables, higher donor age, lower initial graft function, and coronary heart disease were significant for graft loss, whereas patient age and initial graft function were significant for death. In none of these analyses, CMV viremia or disease was a significant factor.
In conclusion, patients with CMV post-transplant show more chronic renal allograft changes early-on, even before CMV infection. Renal allograft loss and death is apparently not related to CMV.
To cite this abstract in AMA style:Erdbruegger U, Scheffner I, Mengel M, Schwarz A, Haller H, Gwinner W. Long-Term Impact of CMV Infection on the Allograft and on Patient Survival in Renal Transplant Patients with Protocol Biopsies [abstract]. Am J Transplant. 2013; 13 (suppl 5). http://atcmeetingabstracts.com/abstract/long-term-impact-of-cmv-infection-on-the-allograft-and-on-patient-survival-in-renal-transplant-patients-with-protocol-biopsies/. Accessed November 24, 2017.
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