Selection of More Vulnerable Patients for Cytomegalovirus Infection in Renal Transplant Recipients With Antithymocyte Globulin Induction Therapy: An Analysis of Risk Factors and Cell-Mediated Immunity. | LitMetric
Division of Vascular and Transplant Surgery, Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. Electronic address:
Published: September 2021
AI Article Synopsis
Article Abstract
Background: Cytomegalovirus (CMV) infection is an important complication after kidney transplantation (KT). Antithymocyte globulin (ATG) increases the risk for CMV infection, and universal prophylaxis is recommended during the first 3 to 6 months after ATG induction in CMV-seropositive recipients. However, following this recommendation is not easy because the cost is high. The aim of this study was to determine who, among high-risk KT recipients, are more vulnerable to CMV infections.
Methods: We retrospectively analyzed the medical records of patients who underwent KT with ATG induction therapy at a single institute from April 2014 to June 2019. We assessed pretransplant recipient characteristics to determine the CMV infection risk factors. Cell-mediated immunity was evaluated with a lymphocyte subset test before transplantation and at the time of discharge. We included 227 patients in the study.
Results: CMV-DNAemia was associated with donor type (deceased donor), the duration of renal replacement therapy, and the ATG dose. Multivariable analysis revealed that donor type is the primary risk factor for CMV-DNAemia. We also found that CD4+ cell counts were significantly lower in CMV-DNAemia recipients at the time of discharge.
Conclusion: The risk for CMV infection in CMV-seropositive KT recipients with ATG induction therapy increases when a graft is received from a deceased donor with renal impairment and when insufficient CD4+ cells are present during recovery.
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Introduction: Cytomegalovirus (CMV) is a virus of the herpesviridae family. CMV infection is associated with increased morbidity and mortality in immunocompromised subjects such as hemodialysis patients and transplant recipients. The aim of our study was to determine the serological status of potential kidney recipients and donors in order to assess the risk of post-transplant CMV infection and disease.
