Journal Article

Impact of Current Transplantation Management on the Development of Cytomegalovirus Disease after Renal Transplantation

Rafael San Juan, José Maria Aguado, Carlos Lumbreras, Jesus Fortun, Patricia Muñoz, Joan Gavalda, Francisco Lopez-Medrano, Miguel Montejo, German Bou, Marino Blanes, Antonio Ramos, Asuncion Moreno, Julian Torre-Cisneros and Jorge Carratalá

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 47, issue 7, pages 875-882
Published in print October 2008 | ISSN: 1058-4838
Published online October 2008 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/591532
Impact of Current Transplantation Management on the Development of Cytomegalovirus Disease after Renal Transplantation

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Background. Current advances in transplantation practices may influence the development of cytomegalovirus (CMV) disease after renal transplantation.

Methods. From September 2003 through February 2005, 1470 renal transplant recipients (55 of whom were kidney-pancreas transplant recipients) were prospectively studied in the 16 transplant centers affiliated with the Spanish Network of Infection in Transplantation, with use of an ad hoc–designed online database. Univariate and multivariate analyses with logistic regression were performed to detect risk factors for CMV disease.

Results. A total of 105 episodes of CMV disease (37 with visceral involvement) developed in 99 (6.7%) of 1470 patients. Attributable mortality appeared in 1 (1.0%) of 105 cases. Multivariate analysis showed that, apart from CMV serological mismatch, presence of rejection episodes, and the use of antilymphocitic drugs, a simultaneous pancreas transplantation (odds ratio [OR], 3.7; 95% confidence interval [CI], 1.5–9), use of cyclosporine (OR, 1.7; 95% CI, 1.18–2.9), a donor >60 years of age (OR, 2.3; 95% CI, 1.5–3.7), and chronic graft malfunction (OR, 1.8; 95% CI, 1.14–2.9) were independently associated with CMV disease, whereas use of sirolimus had a protective effect (OR, 0.27; 95% CI, 0.1–0.78).

Conclusions. Additional risk factors related to current transplantation practices influence the epidemiology of CMV after renal transplantation and should be taken into account in the design of prophylactic strategies in this population of kidney or kidney-pancreas recipients.

Journal Article.  4334 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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