Cytomegalovirus mismatch as major risk factor for delayed graft function after pancreas transplantation

Manuel Maglione, Matthias O. Biebl, Hugo Bonatti, Georg Göbel, Thomas Ratschiller, Stefan Schneeberger, Gerald Brandacher, Paul Hengster, Christian Margreiter, Nicole Berger, Raimund Margreiter, Johann Pratschke, Walter Mark

Research output: Contribution to journalArticle

Abstract

Background. Risk factors for delayed graft function (DGF) in pancreas transplantation (PTx) and its implications on graft survival are poorly defined. Methods. Eighty-seven consecutive first-time PTx for type I diabetes performed between January 2003 and December 2007 were retrospectively reviewed. DGF was defined as a reversible need for exogenous insulin beyond postoperative day 10 (DGF group [DGFG]). For statistical analysis, DGFG patients were compared with patients with immediate graft function (control group [CG]). Results. DGF occurred in 16 patients (18.6%). C-peptide levels and DGF were inversely correlated (r=0.24, P=0.03). In univariate analysis, donor cytomegalovirus (CMV)+ antibody status, and D+/R-CMV mismatch were significantly associated with DGF (81.3% vs. CG 52.1%, P=0.029; and 62.5% vs. CG 21.1%, P=0.002, respectively). Compared with University of Wisconsin solution, histidine tryptophan ketoglutarate-preserved grafts displayed higher DGF rates (37.5% vs. CG 12.7%, P=0.030), similar to female recipients (DGFG 68.8% vs. CG 35.2%, P=0.015). On multivariate analysis, a significantly higher DGF incidence was noted in female recipients (DGFG 68.8% vs. CG 35.2%; P=0.03) and in recipients with D+/R-CMV mismatch (DGFG 62.5% vs. CG 21.1%; P=0.03). With a median follow-up of 40.4 months (range 0.7-74.2), graft survival at 5 years did not differ between both groups (94.4% CG vs. 93.8% DGFG; P=0.791). Conclusion. This is the first study that identifies CMV mismatch (D+/R-) as an additional risk factor for DGF occurrence in PTx. In this particular cohort, DGF does not seem to affect graft survival.

Original languageEnglish (US)
Pages (from-to)666-671
Number of pages6
JournalTransplantation
Volume90
Issue number6
DOIs
StatePublished - Sep 27 2010
Externally publishedYes

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Delayed Graft Function
Pancreas Transplantation
Cytomegalovirus
Control Groups
Graft Survival
Transplants
C-Peptide
Type 1 Diabetes Mellitus
Multivariate Analysis
Tissue Donors
Insulin

Keywords

  • Cytomegalovirus
  • Delayed graft function
  • Pancreas transplantation

ASJC Scopus subject areas

  • Transplantation
  • Medicine(all)

Cite this

Maglione, M., Biebl, M. O., Bonatti, H., Göbel, G., Ratschiller, T., Schneeberger, S., ... Mark, W. (2010). Cytomegalovirus mismatch as major risk factor for delayed graft function after pancreas transplantation. Transplantation, 90(6), 666-671. https://doi.org/10.1097/TP.0b013e3181ea67a1

Cytomegalovirus mismatch as major risk factor for delayed graft function after pancreas transplantation. / Maglione, Manuel; Biebl, Matthias O.; Bonatti, Hugo; Göbel, Georg; Ratschiller, Thomas; Schneeberger, Stefan; Brandacher, Gerald; Hengster, Paul; Margreiter, Christian; Berger, Nicole; Margreiter, Raimund; Pratschke, Johann; Mark, Walter.

In: Transplantation, Vol. 90, No. 6, 27.09.2010, p. 666-671.

Research output: Contribution to journalArticle

Maglione, M, Biebl, MO, Bonatti, H, Göbel, G, Ratschiller, T, Schneeberger, S, Brandacher, G, Hengster, P, Margreiter, C, Berger, N, Margreiter, R, Pratschke, J & Mark, W 2010, 'Cytomegalovirus mismatch as major risk factor for delayed graft function after pancreas transplantation', Transplantation, vol. 90, no. 6, pp. 666-671. https://doi.org/10.1097/TP.0b013e3181ea67a1
Maglione M, Biebl MO, Bonatti H, Göbel G, Ratschiller T, Schneeberger S et al. Cytomegalovirus mismatch as major risk factor for delayed graft function after pancreas transplantation. Transplantation. 2010 Sep 27;90(6):666-671. https://doi.org/10.1097/TP.0b013e3181ea67a1
Maglione, Manuel ; Biebl, Matthias O. ; Bonatti, Hugo ; Göbel, Georg ; Ratschiller, Thomas ; Schneeberger, Stefan ; Brandacher, Gerald ; Hengster, Paul ; Margreiter, Christian ; Berger, Nicole ; Margreiter, Raimund ; Pratschke, Johann ; Mark, Walter. / Cytomegalovirus mismatch as major risk factor for delayed graft function after pancreas transplantation. In: Transplantation. 2010 ; Vol. 90, No. 6. pp. 666-671.
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abstract = "Background. Risk factors for delayed graft function (DGF) in pancreas transplantation (PTx) and its implications on graft survival are poorly defined. Methods. Eighty-seven consecutive first-time PTx for type I diabetes performed between January 2003 and December 2007 were retrospectively reviewed. DGF was defined as a reversible need for exogenous insulin beyond postoperative day 10 (DGF group [DGFG]). For statistical analysis, DGFG patients were compared with patients with immediate graft function (control group [CG]). Results. DGF occurred in 16 patients (18.6{\%}). C-peptide levels and DGF were inversely correlated (r=0.24, P=0.03). In univariate analysis, donor cytomegalovirus (CMV)+ antibody status, and D+/R-CMV mismatch were significantly associated with DGF (81.3{\%} vs. CG 52.1{\%}, P=0.029; and 62.5{\%} vs. CG 21.1{\%}, P=0.002, respectively). Compared with University of Wisconsin solution, histidine tryptophan ketoglutarate-preserved grafts displayed higher DGF rates (37.5{\%} vs. CG 12.7{\%}, P=0.030), similar to female recipients (DGFG 68.8{\%} vs. CG 35.2{\%}, P=0.015). On multivariate analysis, a significantly higher DGF incidence was noted in female recipients (DGFG 68.8{\%} vs. CG 35.2{\%}; P=0.03) and in recipients with D+/R-CMV mismatch (DGFG 62.5{\%} vs. CG 21.1{\%}; P=0.03). With a median follow-up of 40.4 months (range 0.7-74.2), graft survival at 5 years did not differ between both groups (94.4{\%} CG vs. 93.8{\%} DGFG; P=0.791). Conclusion. This is the first study that identifies CMV mismatch (D+/R-) as an additional risk factor for DGF occurrence in PTx. In this particular cohort, DGF does not seem to affect graft survival.",
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AU - Maglione, Manuel

AU - Biebl, Matthias O.

AU - Bonatti, Hugo

AU - Göbel, Georg

AU - Ratschiller, Thomas

AU - Schneeberger, Stefan

AU - Brandacher, Gerald

AU - Hengster, Paul

AU - Margreiter, Christian

AU - Berger, Nicole

AU - Margreiter, Raimund

AU - Pratschke, Johann

AU - Mark, Walter

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N2 - Background. Risk factors for delayed graft function (DGF) in pancreas transplantation (PTx) and its implications on graft survival are poorly defined. Methods. Eighty-seven consecutive first-time PTx for type I diabetes performed between January 2003 and December 2007 were retrospectively reviewed. DGF was defined as a reversible need for exogenous insulin beyond postoperative day 10 (DGF group [DGFG]). For statistical analysis, DGFG patients were compared with patients with immediate graft function (control group [CG]). Results. DGF occurred in 16 patients (18.6%). C-peptide levels and DGF were inversely correlated (r=0.24, P=0.03). In univariate analysis, donor cytomegalovirus (CMV)+ antibody status, and D+/R-CMV mismatch were significantly associated with DGF (81.3% vs. CG 52.1%, P=0.029; and 62.5% vs. CG 21.1%, P=0.002, respectively). Compared with University of Wisconsin solution, histidine tryptophan ketoglutarate-preserved grafts displayed higher DGF rates (37.5% vs. CG 12.7%, P=0.030), similar to female recipients (DGFG 68.8% vs. CG 35.2%, P=0.015). On multivariate analysis, a significantly higher DGF incidence was noted in female recipients (DGFG 68.8% vs. CG 35.2%; P=0.03) and in recipients with D+/R-CMV mismatch (DGFG 62.5% vs. CG 21.1%; P=0.03). With a median follow-up of 40.4 months (range 0.7-74.2), graft survival at 5 years did not differ between both groups (94.4% CG vs. 93.8% DGFG; P=0.791). Conclusion. This is the first study that identifies CMV mismatch (D+/R-) as an additional risk factor for DGF occurrence in PTx. In this particular cohort, DGF does not seem to affect graft survival.

AB - Background. Risk factors for delayed graft function (DGF) in pancreas transplantation (PTx) and its implications on graft survival are poorly defined. Methods. Eighty-seven consecutive first-time PTx for type I diabetes performed between January 2003 and December 2007 were retrospectively reviewed. DGF was defined as a reversible need for exogenous insulin beyond postoperative day 10 (DGF group [DGFG]). For statistical analysis, DGFG patients were compared with patients with immediate graft function (control group [CG]). Results. DGF occurred in 16 patients (18.6%). C-peptide levels and DGF were inversely correlated (r=0.24, P=0.03). In univariate analysis, donor cytomegalovirus (CMV)+ antibody status, and D+/R-CMV mismatch were significantly associated with DGF (81.3% vs. CG 52.1%, P=0.029; and 62.5% vs. CG 21.1%, P=0.002, respectively). Compared with University of Wisconsin solution, histidine tryptophan ketoglutarate-preserved grafts displayed higher DGF rates (37.5% vs. CG 12.7%, P=0.030), similar to female recipients (DGFG 68.8% vs. CG 35.2%, P=0.015). On multivariate analysis, a significantly higher DGF incidence was noted in female recipients (DGFG 68.8% vs. CG 35.2%; P=0.03) and in recipients with D+/R-CMV mismatch (DGFG 62.5% vs. CG 21.1%; P=0.03). With a median follow-up of 40.4 months (range 0.7-74.2), graft survival at 5 years did not differ between both groups (94.4% CG vs. 93.8% DGFG; P=0.791). Conclusion. This is the first study that identifies CMV mismatch (D+/R-) as an additional risk factor for DGF occurrence in PTx. In this particular cohort, DGF does not seem to affect graft survival.

KW - Cytomegalovirus

KW - Delayed graft function

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