Title : Cytomegalovirus infection in the early phase post renal transplantation: A single centre experience
Abstract:
Method: We retrospectively observed all patients that were transplanted in our center between 1.4.18 and 31.3.21. We analyzed data on patients who have developed CMV viremia in the first year post transplantation and followed them for three years.
We focused on clinical characteristics that were transplant and patient related, lab parameters and CMV related variables, co-infection, rejection, and hospitalization rate. We analyzed the impact of IS amendments in order to review our practice and update our local guidelines.
Results: The total number of renal transplant recipients were 205.
The number of patients identified with CMV viremia were 53, 25.8%. Average age at diagnosis was 56.5 ± 14.5 years, M 53% and F 47%.
The majority, 52.8% of the recipients, developed CMV viremia following their first transplant and 20.8% following the second transplant. HLA MM of 2,3 and 4 were related with higher infection rate.
In relation to CMV IgG status, the higher infection rate, 59.6%, was seen in the group D+R+, while 21.2 % in the D-/R+ group and 19.2% in the D+R- group.
CMV prophylaxis was given in only 18.9% of patients.
The rejection rate was calculated as 18.1% and this reflected all types of rejection, including BL-ACR. In this cohort, 17% of the recipients received antirejection treatment.
Co-infections were seen in 56.6% of recipients and hospitalization was required in 39.6% of them. Most common co-infections observed were UTIs, respiratory, EBV and BKV. Less frequently, GI related infections, HSV and two of the patients developed severe Covid infection and died.
Duration from transplantation to infection diagnosis was 119.6 days and duration from diagnosis to CMV resolution was 126.2 days. In the cohort of patients with lower CMV viral load that were monitored and not treated, resolution delayed by 30 days in comparison to the treatment group. Almost 40% of recipients required treatment.
IS was modified, as reduction by 50% of the MMF dose at diagnosis, in all patients who have received treatment, and in 57.5% of the recipients that were monitored and not under treatment for their CMV viremia. Median TAC trough level at diagnosis was 8.1.
There was no compromise in eGFR related to IS reduction and overall related to the CMV infection.
Indications for CMV testing were routine screening, acute graft dysfunction, GI, Respiratory & generalised symptoms, and less frequently neutropenia.
Conclusion: This single-center study provides valuable insights into incidence and characteristics of CMV infection in renal transplant recipients. The observed infection rate 25.8% in the first-year post transplantation underscores the significant burden of CMV in this population. Several risk factors were identified, including MM and CMV serostatus, with D+/R+ patients showing the highest infection rate. The study highlights the importance of CMV prophylaxis, which was underutilized in this cohort. The high rates of co-infections 56.6% and hospitalizations 39.6% emphasize the broader impact of CMV on patient outcomes. Importantly, IS reduction in response to CMV infection did not appear to compromise graft function. These findings underscore the need for vigilant monitoring, timely intervention, and tailored management strategies to mitigate the impact of CMV infection in renal transplant recipients. Future prospective studies and guideline updates should consider these results to optimize CMV prevention and management protocols in renal transplantation.
