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Cytomegalovirus Infection in Seropositive Kidney Transplant Recipients With Diverse Immunological Risks Under

Mun Chae Choi1,2, Minyu Kang3,4, Hwa-Hee Koh3,4

  • 1Department of Surgery, Armed Forces Capital Hospital, Seongnam, South Korea.

Journal of Medical Virology
|June 26, 2025
PubMed

Insights

Cytomegalovirus (CMV) infection significantly impacts kidney transplant recipients, increasing risks of graft loss and mortality. Optimized prevention strategies are crucial, especially for high-risk patients undergoing preemptive management.

Area of Science:

  • Nephrology
  • Transplantation Immunology
  • Infectious Diseases

Background:

  • Cytomegalovirus (CMV) infection is the most common viral infection post-kidney transplant.
  • High-risk patients often receive potent immunosuppression, increasing CMV concern.
  • Preemptive strategies are used, but CMV incidence and outcomes require further study.

Purpose of the Study:

  • To determine the incidence and outcomes of CMV infection in kidney transplant recipients with varying immunological risks.
  • To evaluate the effectiveness of preemptive strategies in managing CMV.
  • To identify risk factors and protective elements associated with CMV infection.

Main Methods:

  • Analysis of 614 CMV-seropositive kidney transplant recipients on preemptive strategies.
  • Inclusion of patients with immunologically incompatible transplants (ABO and HLA).
  • Median follow-up of 60 months with multivariable and Cox regression analyses.

Main Results:

  • CMV infection occurred in 57.7% of patients.
  • Independent risk factors included older recipient age, deceased donor, rituximab, and anti-thymocyte globulin.
  • Mammalian target of rapamycin inhibitor use was protective against CMV infection.

Conclusions:

  • CMV infection is independently associated with increased risk of death-censored graft loss and all-cause mortality.
  • Findings highlight the need for optimized CMV prevention in high-risk kidney transplant recipients.
  • Intensified preemptive strategies or risk-adapted prophylaxis are recommended.
Keywords:
cytomegalovirus infectiongraft survivalimmunological factorskidney transplant

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