Risk of Opportunistic Infection in Kidney Transplant Recipients with Cytomegalovirus Infection and Associated Outcomes
1UW Health, Madison, WI, 2University of Wisconsin-Madison School of Pharmacy, Madison, WI, 3University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
Meeting: 2019 American Transplant Congress
Abstract number: B231
Keywords: Cytomeglovirus, Fungal infection, Kidney transplantation
Session Information
Session Name: Poster Session B: Kidney Infections
Session Type: Poster Session
Date: Sunday, June 2, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Cytomegalovirus (CMV) infection in kidney transplant recipients has been anecdotally observed with concomitant or subsequent opportunistic infections (OI), but this association has yet to be defined or quantified.
*Methods: Patients with CMV infection were matched to controls in a ratio of 1:2 and the rates of opportunistic co-infection were calculated within pre-specified time frames (-30 days to +90 days and -30 days to +180 days). The primary outcome was composite OI rate, and secondary outcomes included time to OI and patient and graft outcomes. CMV-OI association rates were estimated via conditional logistic regression.
*Results: There were 2405 patients who qualified for inclusion; 394 had an episode of CMV infection. These cases were matched to 783 controls with an overall total of 805 participants. Mean time from transplant to CMV diagnosis was 11.5 ±15.7 months. OI occurred in 14 patients in the CMV case group (CMV+) and in 5 patients in the control group (CMV-) in the -30 to +90 day time period (3.55% vs. 0.64%, OR=5.60, 95% CI: 2.02-12.55). When considering 180-day follow-up, OI occurred in 17 CMV+ patients and 8 CMV- patients (4.3% vs. 1%, OR=4.25, 95% CI: 1.83-9.85). Mean time from CMV diagnosis to OI was 33 ± 64 days (median 7 days). The majority of concomitant infections were fungal and accounted for 78.6% of the composite OI at the -30 to +90 day range and 68.4% of the composite OI between -30 to +180 days. Mortality was 3 times more likely in the group with concomitant OI (CMV+/OI+) as compared to a matched cohort of patients with CMV infection without OI (CMV+/OI-) (unadjusted HR 3.02, 1.64-5.55, Table 6). Cumulative survival for CMV+/OI+ patients was significantly worse than CMV+/OI- patients (p<0.01)
*Conclusions: CMV is associated with a significantly increased risk of co-infection with OI, particularly fungal infections. Clinical suspicion for concomitant OI should drive further workup after a CMV diagnosis. Future studies are needed to better define those patients at highest risk to elucidate sub-populations where the benefits of prophylaxis outweigh the potential risks associated with these therapies.
To cite this abstract in AMA style:
Jorgenson M, Descourouez J, Cardinale B, Lyu B, Astor B, Garg N, Saddler C, Smith J, Mandelbrot D. Risk of Opportunistic Infection in Kidney Transplant Recipients with Cytomegalovirus Infection and Associated Outcomes [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/risk-of-opportunistic-infection-in-kidney-transplant-recipients-with-cytomegalovirus-infection-and-associated-outcomes/. Accessed May 8, 2025.« Back to 2019 American Transplant Congress