CMV Mismatch Still Negatively Affects Patient and Graft Survival in the Era of CMV Prophylactic and Preemptive Therapy: A Paired Kidney Analysis

N. Leeaphorn,¹ N. Garg,² N. Thamcharoen,¹ E. Khankin,¹ F. Cardarelli,¹ M. Pavlakis.¹

¹Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA
²Department of Medicine, Nephrology Division, University of Wisconsin School of Medicine, Madison, WI.

Meeting: 2018 American Transplant Congress

Abstract number: 189

Keywords: Cytomeglovirus, Graft survival, Kidney transplantation, Mortality

Session Information

Session Name: Concurrent Session: CMV: Bench to Bedside

Session Type: Concurrent Session

Date: Monday, June 4, 2018

Session Time: 2:30pm-4:00pm

Presentation Time: 3:42pm-3:54pm

Location: Room 608/609

Background: The impact of CMV serostatus on kidney transplant outcomes in an era when CMV prophylactic and preemptive strategies are used routinely is not clearly established. We aimed to investigate this association through a donor-paired kidney analysis.

Methods: Using UNOS/OPTN data, adult patients with first deceased donor kidney transplant between 2010 and 2015 were stratified into 4 groups in the main cohort: D-/R-, D+/R-, D+/R+, and D-/R+. In a paired kidney cohort, we identified 2,899 pairs of D- kidney transplant with discordance of recipient serostatus (D-/R- vs D-/R+) and 4,567 pairs of D+ kidney transplant with discordance of recipient serostatus (D+/R- vs D+/R+). Death-censored graft survival, all-cause mortality and mortality due to infection were examined in both cohorts.

Results: In the multivariable analysis of the main cohort which included 52,394 recipients, D+/R- was associated with an increased risk of graft failure (HR=1.15, P=0.015), all-cause mortality (HR=1.18, P=0.001) and mortality due to infection (HR=1.46, P=0.007) when compared to D-/R-. There was also an increased risk of graft failure in D+/R+ when compared to D-/R- (HR=1.06, P=0.042). In the paired kidney multivariable analysis, D+/R- was an independent risk factor for all-cause mortality (HR=1.15, P=0.011) and infection-related mortality (HR=1.31, P=0.046) when compared to D+/R+. No difference in graft loss between D+/R- and D+/R+ in the paired kidney cohort.

Conclusions: CMV mismatch (D+/R-) is still an independent risk factor for graft loss and patient mortality in the era of effective prophylactic and preemptive strategies. The negative impact of D+/R- serostatus on all-cause mortality and infection-related mortality persists after fully matching for donor factors.

CITATION INFORMATION: Leeaphorn N., Garg N., Thamcharoen N., Khankin E., Cardarelli F., Pavlakis M. CMV Mismatch Still Negatively Affects Patient and Graft Survival in the Era of CMV Prophylactic and Preemptive Therapy: A Paired Kidney Analysis Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Leeaphorn N, Garg N, Thamcharoen N, Khankin E, Cardarelli F, Pavlakis M. CMV Mismatch Still Negatively Affects Patient and Graft Survival in the Era of CMV Prophylactic and Preemptive Therapy: A Paired Kidney Analysis [abstract]. https://atcmeetingabstracts.com/abstract/cmv-mismatch-still-negatively-affects-patient-and-graft-survival-in-the-era-of-cmv-prophylactic-and-preemptive-therapy-a-paired-kidney-analysis/. Accessed May 9, 2025.

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