Backgrounds: Cytomegalovirus (CMV) prophylaxis is recommended for CMV-seronegative kidney transplant recipients (R-) receiving the grafts from CMV seropositive donors (D+). Meanwhile, whether R+ patients need universal CMV prophylaxis remains undefined. Most of R+ patients with low-grade CMV reactivation show spontaneous remission without deteriorating the graft function and survival. In addition, valganciclovir (VGCV) possibly causes some adverse effects and GCV-resistant CMV. Although targeting CMV prophylaxis to R+ patients is ideal, there are few reports addressing the risk factors of high-grade CMV reactivation in R+ patients in the modern immunosuppressive era.
Methods: Since July 2004, 137 R+ patients who received the kidney from D+ in our hospital were enrolled in this study. No recipients received CMV prophylaxis. The induction immunosuppressive therapy was consisted of tacrolimus, MMF, steroid, and basiliximab. Patients with immunological high risks received a single-low dose of rituximab and 3 to 4 sessions of apheresis prior to transplantation. High-grade CMV reactivation was defined as CMV-antigenemia (Ag) positive cells becoming higher than 10/200,000 blood leukocytes during the clinical course. The CMV-Ag level was monitored at 2 to 3-weekly intervals until 6 months, and at monthly intervals from 6 to 12 months post-transplantation. We investigated the predictive risk factors of high-grade CMV reactivation in R+ patients.
Results: The rate of high-grade CMV reactivation was 25% (34/137) in this series. All patients who developed CMV reactivation were cured by VGCV or GCV successfully without causing GCV-resistant CMV. The graft survival was significantly shorter in the R+ patients with CMV reactivation than those without (p=0.014). In multivariate analysis, the pre-transplant low-IgG titer against CMV (p=0.010) and immunological high risks (p=0.028) were independently associated with the development of high-grade CMV reactivation.
Conclusion: The development of high-grade CMV reactivation deteriorated the graft survival in R+ patients in the modern immunosuppressive era. Pre-transplant low-IgG titer against CMV and immunological high risks were predictive risk factors for the development of high-grade CMV reactivation. To avoid the high-grade CMV reactivation, targeting CMV prophylaxis may be needed for R+ patients with risk factors as stated above.
To cite this abstract in AMA style:Saito M, Satoh S, Numakura K, Inoue T, Tsuruta H, Akihama S, Tsuchiya N, Habuchi T. Risk Factors of Post-Transplant High-Grade CMV Reactivation in CMV-Seropositive Patients in the Modern Immunosuppressive Era [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/risk-factors-of-post-transplant-high-grade-cmv-reactivation-in-cmv-seropositive-patients-in-the-modern-immunosuppressive-era/. Accessed May 6, 2021.
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