Cytomegalovirus disease in African-American kidney transplant patients

J. McGee, Vidya Mave, C. L. Yau, M. Killackey, A. Paramesh, J. Buell, D. P. Slakey, L. L. Hamm, R. Zhang

Research output: Contribution to journalArticle

Abstract

Background: Cytomegalovirus (CMV) disease is a serious infection after kidney transplantation. The risk factors and the impact of CMV disease in African-American (AA) kidney transplant patients have not been well characterized. Methods: We performed a retrospective analysis on 448 AA patients transplanted between 1996 and 2005. A 3-month universal chemoprophylaxis with ganciclovir or valganciclovir was administered to CMV donor-positive/recipient-negative (D+/R-) patients and to those treated with anti-thymocyte globulin for rejection, but not routinely to those with other D/R serostatus. Results: A total of 31 AA patients (7%) developed clinical CMV disease. Compared with other D/R serostatus groups, the D+/R- group had the highest 3-year cumulative incidence of CMV disease (16.9% vs. 6.3% in D+/R+, 4.9% in D-/R+, and 2.4% in D-/R-). The D+/R- group also had the worst 3-year death-censored allograft survival (75% vs. 92% in D+/R+, 94% in D-/R+, and 96% in D-/R-, log-rank P = 0.01). Multivariate analysis found that D+/R- serostatus (odds ratio [OR] 5.4, 95% confidence interval [CI] 0.6-48.2, P = 0.003) and donor age > 60 years (OR 9.1, 95% CI 1.3-65, P = 0.03) were independent risk factors for CMV disease. Conclusion: The D+/R- group has the highest incidence of CMV disease and the worst 3-year renal allograft survival despite 3-month universal prophylaxis. Prolonged chemoprophylaxis may be needed to prevent the late development of CMV disease and to improve allograft survival in the high-risk group of AA kidney transplant recipients.

Original languageEnglish (US)
Pages (from-to)604-610
Number of pages7
JournalTransplant Infectious Disease
Volume14
Issue number6
DOIs
StatePublished - Dec 2012
Externally publishedYes

Fingerprint

Cytomegalovirus
African Americans
Transplants
Kidney
Allografts
Chemoprevention
Odds Ratio
Tissue Donors
Confidence Intervals
Ganciclovir
Antilymphocyte Serum
Incidence
Kidney Transplantation
Multivariate Analysis
Infection

Keywords

  • African-American
  • CMV prophylaxis
  • Cytomegalovirus
  • Graft survival
  • Kidney transplant

ASJC Scopus subject areas

  • Transplantation
  • Infectious Diseases

Cite this

McGee, J., Mave, V., Yau, C. L., Killackey, M., Paramesh, A., Buell, J., ... Zhang, R. (2012). Cytomegalovirus disease in African-American kidney transplant patients. Transplant Infectious Disease, 14(6), 604-610. https://doi.org/10.1111/j.1399-3062.2012.00759.x

Cytomegalovirus disease in African-American kidney transplant patients. / McGee, J.; Mave, Vidya; Yau, C. L.; Killackey, M.; Paramesh, A.; Buell, J.; Slakey, D. P.; Hamm, L. L.; Zhang, R.

In: Transplant Infectious Disease, Vol. 14, No. 6, 12.2012, p. 604-610.

Research output: Contribution to journalArticle

McGee, J, Mave, V, Yau, CL, Killackey, M, Paramesh, A, Buell, J, Slakey, DP, Hamm, LL & Zhang, R 2012, 'Cytomegalovirus disease in African-American kidney transplant patients', Transplant Infectious Disease, vol. 14, no. 6, pp. 604-610. https://doi.org/10.1111/j.1399-3062.2012.00759.x
McGee, J. ; Mave, Vidya ; Yau, C. L. ; Killackey, M. ; Paramesh, A. ; Buell, J. ; Slakey, D. P. ; Hamm, L. L. ; Zhang, R. / Cytomegalovirus disease in African-American kidney transplant patients. In: Transplant Infectious Disease. 2012 ; Vol. 14, No. 6. pp. 604-610.
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title = "Cytomegalovirus disease in African-American kidney transplant patients",
abstract = "Background: Cytomegalovirus (CMV) disease is a serious infection after kidney transplantation. The risk factors and the impact of CMV disease in African-American (AA) kidney transplant patients have not been well characterized. Methods: We performed a retrospective analysis on 448 AA patients transplanted between 1996 and 2005. A 3-month universal chemoprophylaxis with ganciclovir or valganciclovir was administered to CMV donor-positive/recipient-negative (D+/R-) patients and to those treated with anti-thymocyte globulin for rejection, but not routinely to those with other D/R serostatus. Results: A total of 31 AA patients (7{\%}) developed clinical CMV disease. Compared with other D/R serostatus groups, the D+/R- group had the highest 3-year cumulative incidence of CMV disease (16.9{\%} vs. 6.3{\%} in D+/R+, 4.9{\%} in D-/R+, and 2.4{\%} in D-/R-). The D+/R- group also had the worst 3-year death-censored allograft survival (75{\%} vs. 92{\%} in D+/R+, 94{\%} in D-/R+, and 96{\%} in D-/R-, log-rank P = 0.01). Multivariate analysis found that D+/R- serostatus (odds ratio [OR] 5.4, 95{\%} confidence interval [CI] 0.6-48.2, P = 0.003) and donor age > 60 years (OR 9.1, 95{\%} CI 1.3-65, P = 0.03) were independent risk factors for CMV disease. Conclusion: The D+/R- group has the highest incidence of CMV disease and the worst 3-year renal allograft survival despite 3-month universal prophylaxis. Prolonged chemoprophylaxis may be needed to prevent the late development of CMV disease and to improve allograft survival in the high-risk group of AA kidney transplant recipients.",
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T1 - Cytomegalovirus disease in African-American kidney transplant patients

AU - McGee, J.

AU - Mave, Vidya

AU - Yau, C. L.

AU - Killackey, M.

AU - Paramesh, A.

AU - Buell, J.

AU - Slakey, D. P.

AU - Hamm, L. L.

AU - Zhang, R.

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N2 - Background: Cytomegalovirus (CMV) disease is a serious infection after kidney transplantation. The risk factors and the impact of CMV disease in African-American (AA) kidney transplant patients have not been well characterized. Methods: We performed a retrospective analysis on 448 AA patients transplanted between 1996 and 2005. A 3-month universal chemoprophylaxis with ganciclovir or valganciclovir was administered to CMV donor-positive/recipient-negative (D+/R-) patients and to those treated with anti-thymocyte globulin for rejection, but not routinely to those with other D/R serostatus. Results: A total of 31 AA patients (7%) developed clinical CMV disease. Compared with other D/R serostatus groups, the D+/R- group had the highest 3-year cumulative incidence of CMV disease (16.9% vs. 6.3% in D+/R+, 4.9% in D-/R+, and 2.4% in D-/R-). The D+/R- group also had the worst 3-year death-censored allograft survival (75% vs. 92% in D+/R+, 94% in D-/R+, and 96% in D-/R-, log-rank P = 0.01). Multivariate analysis found that D+/R- serostatus (odds ratio [OR] 5.4, 95% confidence interval [CI] 0.6-48.2, P = 0.003) and donor age > 60 years (OR 9.1, 95% CI 1.3-65, P = 0.03) were independent risk factors for CMV disease. Conclusion: The D+/R- group has the highest incidence of CMV disease and the worst 3-year renal allograft survival despite 3-month universal prophylaxis. Prolonged chemoprophylaxis may be needed to prevent the late development of CMV disease and to improve allograft survival in the high-risk group of AA kidney transplant recipients.

AB - Background: Cytomegalovirus (CMV) disease is a serious infection after kidney transplantation. The risk factors and the impact of CMV disease in African-American (AA) kidney transplant patients have not been well characterized. Methods: We performed a retrospective analysis on 448 AA patients transplanted between 1996 and 2005. A 3-month universal chemoprophylaxis with ganciclovir or valganciclovir was administered to CMV donor-positive/recipient-negative (D+/R-) patients and to those treated with anti-thymocyte globulin for rejection, but not routinely to those with other D/R serostatus. Results: A total of 31 AA patients (7%) developed clinical CMV disease. Compared with other D/R serostatus groups, the D+/R- group had the highest 3-year cumulative incidence of CMV disease (16.9% vs. 6.3% in D+/R+, 4.9% in D-/R+, and 2.4% in D-/R-). The D+/R- group also had the worst 3-year death-censored allograft survival (75% vs. 92% in D+/R+, 94% in D-/R+, and 96% in D-/R-, log-rank P = 0.01). Multivariate analysis found that D+/R- serostatus (odds ratio [OR] 5.4, 95% confidence interval [CI] 0.6-48.2, P = 0.003) and donor age > 60 years (OR 9.1, 95% CI 1.3-65, P = 0.03) were independent risk factors for CMV disease. Conclusion: The D+/R- group has the highest incidence of CMV disease and the worst 3-year renal allograft survival despite 3-month universal prophylaxis. Prolonged chemoprophylaxis may be needed to prevent the late development of CMV disease and to improve allograft survival in the high-risk group of AA kidney transplant recipients.

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KW - CMV prophylaxis

KW - Cytomegalovirus

KW - Graft survival

KW - Kidney transplant

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