*Purpose: Cytomegalovirus (CMV) nephritis is an uncommon end-organ manifestation of CMV disease. Due to this, associated outcomes have not been completely elucidated.

*Methods: This was a single-center case-series of adult kidney transplant recipients (KTR)s diagnosed with biopsy-proven CMV nephritis from 1997 to 2020. Primary objective was to describe epidemiology and outcomes associated with this diagnosis.

*Results: 12 KTRs had biopsy-proven CMV nephritis within the study period, with mean interval from transplant to diagnosis of 6.8 ± 4.3 mos. 5 KTRs (42%) were high risk for CMV (D+/R-); the remaining 7 intermediate. Median interval from transplant to first detectable CMV was 3.5 mos (IQR = 3.9 mos). As CMV detection has evolved over time, only 3 KTRs underwent quantitative PCR testing. Mean CMV level at biopsy in these patients was 2.4 million ± 3.5 million IU/mL. Most KTRs were symptomatic (n =10, 83%) mainly with diarrhea (n = 7, 70%), fever, fatigue, and nausea (all n =3, 30%). The most common lab findings were AKI (n=10, 83%) and leukopenia (n = 4, 33%). Main biopsy features were glomerular CMV inclusions (n = 7, 58%) followed by the tubulointerstitial inclusions (n = 6, 50%). The most common concomitant end-organ CMV manifestations were gastrointestinal, with 2 cases of biopsy-proven CMV colitis (16%) followed by esophagitis (n=1, 8%). No cases of CMV retinitis, hepatitis or pneumonitis were seen. 11 KTRs were treated with IV ganciclovir. 6 (55%) received IVIG. Antimetabolite discontinuation occurred in 83% (n= 10) in response to CMV diagnosis. A renal biopsy of one patient is presented below in Figure 1. 11 KTRs (92%) experienced graft failure, of which 5 (42%) were death-censored. 5 KTRS (42%) had rejection: 3 patients having concurrent rejection at the time of index biopsy, 2 had rejection at 2 and 3 months post biopsy. Mean SCr at 12 mos post-index biopsy was 1.8 ± 0.6 mg/dL (n = 8) compared to a mean SCr at the time of biopsy of 3.0 ± 1.5 mg/dL.

*Conclusions: CMV nephritis is rare but can cause significant graft dysfunction associated with poor patient/allograft outcomes. Unifying characteristics include CMV high risk status, high viral load, AKI and leukopenia in the setting of symptomatic disease. Early identification and prompt treatment of CMV infection may prevent end organ manifestations and improve outcomes.

« Back to 2021 American Transplant Congress