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Published on: December 16, 2017

Risk factors and impact of cytomegalovirus disease in simultaneous pancreas-kidney transplantation

D B Kaufman1, J R Leventhal, L G Gallon

  • 1Department of Surgery, Division of Transplantation, Northwestern University Medical School, Chicago, IL 60611, USA.

Transplantation
|January 5, 2002
PubMed
Abstract

Insights

Cytomegalovirus (CMV) disease remains a significant concern following simultaneous pancreas kidney (SPK) transplants. Donor CMV serology is a key risk factor, necessitating improved prophylaxis strategies.

Area of Science:

  • Transplantation Immunology
  • Infectious Diseases
  • Organ Transplantation

Background:

  • Cytomegalovirus (CMV) relevance in simultaneous pancreas kidney (SPK) transplant recipients is under-quantified despite modern immunosuppression and antiviral therapies.
  • This study evaluates risk factors for CMV disease and its impact on SPK transplant outcomes under a consistent immunosuppression and prophylaxis regimen.

Purpose of the Study:

  • To determine risk factors for cytomegalovirus (CMV) disease in SPK transplant recipients.
  • To assess the impact of CMV disease on SPK transplant outcomes.
  • To evaluate the effect of CMV prophylaxis duration on disease timing and severity in high-risk recipients.

Main Methods:

  • Retrospective, single-center study of 100 consecutive SPK transplant recipients.
  • Standardized immunosuppression (mycophenolate mofetil, tacrolimus, prednisone) and CMV prophylaxis (ganciclovir, +/- CMV hyperimmune globulin) were used.
  • Multivariate analysis identified risk factors for CMV disease and adverse outcomes.

Main Results:

  • The 1-year incidence of CMV disease was 17.0% (12.0% noninvasive, 5.0% invasive).
  • Donor CMV serology positivity (D+/R+ or D+/R-) significantly predicted CMV disease (RR 63.37, P=0.0052).
  • Invasive CMV disease predicted mortality but did not affect allograft survival; prophylaxis duration delayed onset but not severity.

Conclusions:

  • SPK transplant outcomes have improved, but CMV remains a critical pathogen.
  • Donor CMV serological status and prophylaxis duration predict CMV disease occurrence.
  • Novel strategies are required to mitigate CMV disease risk and severity in SPK recipients.

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