*Purpose: Cytomegalovirus (CMV) infection after kidney transplantation is associated with a high morbidity and higher risk of graft loss. A latent Human CMV infection can occur due to various mechanisms such as inhibition of antigen presentation and production of HLA class 1-like protein. In this study, the relationship between CMV infection post-kidney transplantation and HLA, and between killer immunoglobulin-like receptor (KIR) compatibility of recipients and donors was evaluated.

*Methods: We included 157 cases of donor-recipient with a pre-transplant CMV positive status, among patients who received a living kidney transplants at Akita University Hospital from December 2007 to November 2014. CMV infection was positive when the number of antigen-positive cells in the blood was ≥ 2. HLA and KIR genotypes were determined by WAKFlow® and LAB type® reagents.

*Results: Seventy-nine cases were diagnosed with CMV infection after renal transplant, while 78 cases were uninfected. CMV infection after renal transplantation was significantly lower in the HLA full match group than in the HLA mismatch group (12.5 vs. 51.7%, p=0.033). More specifically in the 2-match case group of HLA-A, -Cw and -DQ, the incidence was significantly lower than in the 0- or 1-match case group (25.0 vs. 52.5%, p=0.037, 20.0 vs. 52.4%, p=0.032 and 15.4 vs. 53.5%, p=0.005, respectively). On the other hand, the recipient-donor HLA match was not associated with suppression of CMV infection in any serotypes of the HLA-A, -B, -Cw, -DR and -DQ loci. KIR-ligand mismatch between recipient KIR and donor HLA[A2] showed a significant higher incidence when there was a mismatch in either KIR2DL2&HLA-Cw C1 or KIR2DL1/3&C2 group (12.7 vs. 25.6%, p=0.044).

*Conclusions: HLA match and KIR ligand match in kidney transplantation are important not only for suppressing alloresponse but also for reducing the risk of infections, such as CMV.

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