Association between CMV Infection and Subsequent BKV Infection after Kidney and Kidney/Pancreas Transplant – 4.5 Years of Experience in a Single Center, The
Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
Infectious Disease/Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH
Quantitative Health Science, Cleveland Clinic Foundation, Cleveland, OH
Meeting: 2013 American Transplant Congress
Abstract number: D1750
Introduction: Cytomegalovirus (CMV) infection and BK virus (BKV) infection are serious infections after kidney and kidney/pancreas transplant. The association between these two viral infections has not been well studied.
OBJECTIVES: To assess the association between CMV infection and the subsequent BKV infection after kidney and kidney/pancreas transplant.
METHODS: We prospectively screened 609 patients who had undergone kidney or kidney/pancreas transplant (Tx) form January 2007 to June 2011 for the occurrence of BKV and/or CMV viremia. This included 7,453 tests for quantitative BKV PCR and 15,496 tests for quantitative CMV PCR. We identified the incidence of BKV infection following CMV infection.
RESULTS: The overall incidence of CMV infection and CMV disease were 100/609 (16.4%) and 8/609 (1.3%), respectively. The mean ± standard deviation (SD) months to positive CMV PCR were 6.9 ± 4.0 months. The mean age 50.9 ± 12.0 years with 62% male. Risk factors were D+R- serogroup (p= <0.0001), Donor age > 50 years (p= 0.013), higher mean Tacrolimus (Tac) blood level (p=0.0009), and higher mean Mycophenolate mofeteal (MMF) blood level (p=0.01) using both univariable and multivariable analysis. Following CMV infection, mean blood level of Tac and MMF were intentionally lowered from (9.8 ng/mL and 2.9 mcg/mL) to (8.5ng/mL and 2.2 mcg/mL), respectively compared to (9.3 ng/mL and 2.6 mcg/mL) in the CMV PCR negative group (p= <0.0001). The incidence of BKV infection in the total population was 163/609 (26.7%), of which 150 (92%) occurred in the CMV PCR negative group. CMV PCR negative group showed higher risk to develop BKV infection than CMV PCR positive group (p= 0.003, HR= 2.1, 95% CI= 1.2-3.4).
CONCLUSION: CMV viremia may indirectly protect against subsequent BK viremia perhaps due to reduction of immunosuppressive drugs after diagnosis of CMV viremia.
To cite this abstract in AMA style:
Elfadawy N, Flechner S, Mossad S, Avery R, Schold J, Liu X. Association between CMV Infection and Subsequent BKV Infection after Kidney and Kidney/Pancreas Transplant – 4.5 Years of Experience in a Single Center, The [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/association-between-cmv-infection-and-subsequent-bkv-infection-after-kidney-and-kidneypancreas-transplant-4-5-years-of-experience-in-a-single-center-the/. Accessed May 21, 2025.« Back to 2013 American Transplant Congress