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Risk Factors for Breakthrough Cytomegalovirus Infections While on Prophylaxis in Kidney and Pancreas Transplant
Kayla Moody1, Jennifer Byrns1, Lexie Zidanyue Yang2
1Department of Pharmacy, Duke University Hospital, Durham, North Carolina, USA.
Summary
Breakthrough cytomegalovirus (CMV) infection affects over 30% of transplant patients. Delayed graft function is a significant risk factor, suggesting prophylaxis adjustments may reduce CMV infection risk.
Area of Science:
- Transplantation Immunology
- Virology
- Nephrology
Background:
- Breakthrough cytomegalovirus (CMV) infection post-transplant can cause significant morbidity.
- Antiviral prophylaxis is standard for CMV prevention in transplant recipients.
Purpose of the Study:
- To determine the incidence of breakthrough CMV infection in kidney and pancreas transplant recipients.
- To identify risk factors associated with breakthrough CMV infection during antiviral prophylaxis.
Main Methods:
- Single-center retrospective cohort study of 408 kidney/pancreas transplant episodes (2018-2021).
- Patients received post-transplant CMV antiviral prophylaxis.
- Multivariable Cox regression analyzed risk factors, including delayed graft function (DGF) and rejection.
Main Results:
- Breakthrough CMV infection occurred in 30.8% (125/408) of patients.
- Median time to detection was 30 days post-transplant.
- Delayed graft function (DGF) was a significant risk factor (HR 1.68, p<0.01); higher incidence of DGF, longer cold ischemic time, and deceased donor transplants were associated with breakthrough infection.
Conclusions:
- Delayed graft function (DGF) is a key risk factor for breakthrough CMV infection.
- Optimizing antiviral prophylaxis dosing in patients with DGF may reduce CMV infection risk and complications.
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