Does a Second Transplant Increase the Risk for CMV Infection? An Evaluation of the Incidence of CMV Viremia in the Previously Transplanted Kidney Recipient
1Pharmacy, Duke University Hospital, Durham, NC, 2Medicine, Duke University Medical Center, Durham, NC
Meeting: 2022 American Transplant Congress
Abstract number: 995
Keywords: Cytomeglovirus, Kidney transplantation, Prophylaxis, Retransplantation
Topic: Clinical Science » Infection Disease » 25 - Kidney Infectious Non-Polyoma & Non-Viral Hepatitis
Session Information
Session Name: Kidney Infectious Non-Polyoma & Non-Viral Hepatitis
Session Type: Poster Abstract
Date: Sunday, June 5, 2022
Session Time: 7:00pm-8:00pm
Presentation Time: 7:00pm-8:00pm
Location: Hynes Halls C & D
*Purpose: Cytomegalovirus (CMV) viremia is a common complication of kidney transplant recipients (KTR) with significant morbidity/mortality. Patients who receive multiple transplants are potentially at a higher risk for CMV viremia given prolonged immunosuppression exposure, and higher sensitization profile thereby requiring a higher degree of immunosuppression. The purpose of this study is to investigate the incidence of CMV viremia in KTR who previously received any solid organ transplant (SOT).
*Methods: This was a retrospective, single center study, evaluating the incidence of CMV viremia in KTR between 1/1/2014-5/1/2021, and had a prior SOT of any organ type. The primary endpoint was the incidence of CMV viremia. Secondary endpoints included patient/graft survival and incidence of biopsy proven rejection (BPAR). Descriptive statistics were expressed as absolute numbers (%) for categorical data and as median with interquartile range (IQR) for skewed distribution.
*Results: There were 102 patients who met the criteria in the study period of 2014-2021. Patients were mostly male (62.7%), white (54.9%), received a previous kidney transplant (62.7%), with the average time between SOT of 12.7 years (table 1). Mean panel reactive antibody (PRA) class I/II was 31.7/30.6%. The incidence of CMV viremia was 46.1%, with mean time to reactivation of 209 days. Only 22.5% of patients in the cohort were considered CMV high risk (D+/R-) and over 65.7% of patients received valganciclovir prophylaxis. Patient/graft survival at 1 year were excellent at 100% and BPAR was low at 7.8% (table 2).
*Conclusions: Patients who require a KT after receiving a previous SOT are at a higher risk for developing CMV viremia given prolonged exposure to immunosuppression. In our study almost half the patients had CMV reactivation, with the majority being of moderate risk profile (CMV D+/R+ or D-/R+). Given the high reactivation rates seen in this patient cohort, it is imperative for patients who receive multiple transplants to receive appropriate CMV prophylaxis and have serial CMV polymerase chain reaction (PCR) tests performed regularly for early detection of CMV viremia.
To cite this abstract in AMA style:
Byrns J, Katz-Greenberg G. Does a Second Transplant Increase the Risk for CMV Infection? An Evaluation of the Incidence of CMV Viremia in the Previously Transplanted Kidney Recipient [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/does-a-second-transplant-increase-the-risk-for-cmv-infection-an-evaluation-of-the-incidence-of-cmv-viremia-in-the-previously-transplanted-kidney-recipient/. Accessed November 23, 2024.« Back to 2022 American Transplant Congress