Cytomegalovirus Reactivation in Seropositive Kidney Transplant Recipients: A Retrospective Analysis of a UK Cohort

Cytomegalovirus infection is the most common opportunistic infection affecting organ transplant recipients and is associated with detrimental allograft and patient outcomes. In recipients previously seronegative for cytomegalovirus, acquired infection is termed primary infection, whereas infection acquired in recipients with previously confirmed seropositivity is called reactivation. Cytomegalovirus seropositivity carries a great risk of reactivation, and management for these patients may vary, from dug prophylaxis to pre emptive viral monitoring.We soughtto determine the incidence of cytomegalovirus reactivation in kidney recipients with cytomegalovirus seropositivity and to assess risk factors.

We conducted a retrospective study at our center to determine the overall incidence of cytomegalovirus reactivation and associated risk factors in kidney transplant recipients with cytomegalovirus seropositivity within 12 months of transplant. For the period January 2015 to January 2021, we studied 97 transplant recipients who were seropositive for cytomegalovirus.

Cytomegalovirus reactivation developed in 49 of 97 recipients (50.5%); cytomegalovirus reactivation developed in 63% of recipients ≥65 years versus 42% <65 years (P = .046); and 76% of cytomegalovirus reactivations occurred within the first 3 months after transplant (P <.001). Mean glomerular filtration rate at 12 months was significantly lower in patients with cytomegalovirus reactivation (37.86 mL/min) versus without reactivation (50.85 mL/min; P = .005). Binary logistic regression analysis revealed recipient age ≥65 years as a predictor of cytomegalovirus reactivation on univariate analysis.

Kidney transplant recipients ≥65 years were more likely to develop cytomegalovirus reactivation in the first 3 to 6 months posttransplant. Kidney allograft function at 12 months was significantly lower in recipients with cytomegalovirus reactivation. Our results suggest that universal cytomegalovirus drug prophylaxis in kidney recipients with cytomegalovirus seropositivity may help reduce cytomegalovirus reactivation and prevent associated adverse outcomes in older kidney transplant recipients.