Transplant international : official journal of the European Society for Organ Transplantation 2017 04 22() doi 10.1111/tri.12972
Transplant recipients are prone to viral infections, which could affect renal transplantation outcome. Our aim was to assess the effects of early human cytomegalovirus (CMV) DNAemia on transplant renal function.
264 (age 50.9±13.5; male 55%) Renal transplantation recipients undergoing preemptive anti-CMV therapy were retrospectively categorized based on early (<3 months post-Tx) CMV peak viral load (PVL); PVL≤536, PVL536-6310 or PVL>6310 International Units/ml (IU/ml). Estimated Glomerular Filtration Rate (eGFR) was analyzed between 1 and 36 months post-transplantation with Kruskal-Wallis test, linear regression and a Linear Mixed-Effects Model.
CMV infection was detectable in 113 (43%) recipients within 49 [38-67] days. Subjects with PVL>6310 had statistically significant ~5-13 ml/min lower eGFR between 3 and 36 months compared to PVL≤536 and PVL536-6310. eGFR declined from 46.1 to 40.7 ml/min/1.73m(2) (-12%) over three years and the annual decrease for pronounced infection with high PVL was 2.0 mL/min/1.73m(2) faster than for non- or mildly infected subjects.
In conclusion, high CMV DNAemia early after renal transplantation was associated with significant loss of renal function, from which subjects did not recover. The severity of infection (high PVL early post-transplantation), more than the infection per se, was related to irreversible and progressive loss of renal function. This article is protected by copyright. All rights reserved.