Delayed-Onset Primary Cytomegalovirus Disease and the Risk of Allograft Failure and Mortality after Kidney Transplantation
Background. During the contemporary era of antiviral prophylaxis, the impact of delayed-onset primary cytomegalovirus (CMV) disease on the outcome of kidney transplantation is not known. We evaluated the incidence, clinical features, risk factors, and outcomes of CMV disease among high-risk kidney t...
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| Veröffentlicht in: | Clinical infectious diseases 2008-03, Vol.46 (6), p.840-846 |
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| creator | Arthurs, Supha K. Eid, Albert J. Pedersen, Rachel A. Kremers, Walter K. Cosio, Fernando G. Patel, Robin Razonable, Raymund R. |
| description | Background. During the contemporary era of antiviral prophylaxis, the impact of delayed-onset primary cytomegalovirus (CMV) disease on the outcome of kidney transplantation is not known. We evaluated the incidence, clinical features, risk factors, and outcomes of CMV disease among high-risk kidney transplant recipients. Methods. The medical records of CMV-seronegative recipients of kidney transplants from CMV-seropositive donors were reviewed. Cox proportional hazards regression was used to identify factors associated with CMV disease and to assess its impact on allograft loss and mortality. Results. None of the 176 CMV-seronegative recipients of kidney transplants from CMV-seropositive donors developed breakthrough CMV disease during a median of 92 days (interquartile range, 90–92 days) of oral ganciclovir or valganciclovir prophylaxis. Thereafter, 51 patients (29%) developed CMV disease at a median of 61 days (interquartile range, 40–143 days) after stopping antiviral prophylaxis. Early-onset bacterial and fungal infection (hazard ratio, 3.61; 95% confidence interval, 1.78–7.33; P |
| doi_str_mv | 10.1086/528718 |
| format | Article |
| fullrecord | <record><control><sourceid>jstor_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_70312483</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><jstor_id>40307105</jstor_id><oup_id>10.1086/528718</oup_id><sourcerecordid>40307105</sourcerecordid><originalsourceid>FETCH-LOGICAL-c517t-8df0aac0686278d9e2034dc6ffa5d9e76be1f9a334f48a564d5deb036e4903553</originalsourceid><addsrcrecordid>eNqFkl1rFDEYhQdRbK36D5Qo6N1oPiZfl2X7JVYqWqF4E7Iz79Rss5M1yRTHX2_KLFsQxKsknIeTN-ekqp4T_I5gJd5zqiRRD6p9wpmsBdfkYdljrupGMbVXPUlphTEhCvPH1R5RVGCp-H71-wi8naCrL4YEGX2Obm3jhBZTDmu4tj7cujgmdOQS2ATIDh3KPwB9cekGhR4deh-uo-0zOrHOj3EmPoWYrXd5QkWBiD66boAJXUY7pI23Q7bZheFp9ai3PsGz7XpQfTs5vlyc1ecXpx8Wh-d1y4nMtep6bG2LhRJUqk4DxazpWtH3lpeTFEsgvbaMNX2jLBdNxztYYiag0Zhxzg6qt7PvJoafI6Rs1i614MsgEMZkJGaElpT-C1KsmaZSF_D1X-AqjHEojzCUaC1pmeLerY0hpQi92czhGoLNXWdm7qyAL7du43IN3T22LakAb7aATa31fYmxdWnHUUwEbejd_K9mLoybf1_2YmZWKYe4oxrMsCzfpej1rLuU4ddOt_HGCMkkN2dX381XSq80l6cGsz9SqsCc</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>219972564</pqid></control><display><type>article</type><title>Delayed-Onset Primary Cytomegalovirus Disease and the Risk of Allograft Failure and Mortality after Kidney Transplantation</title><source>Jstor Complete Legacy</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Arthurs, Supha K. ; Eid, Albert J. ; Pedersen, Rachel A. ; Kremers, Walter K. ; Cosio, Fernando G. ; Patel, Robin ; Razonable, Raymund R.</creator><creatorcontrib>Arthurs, Supha K. ; Eid, Albert J. ; Pedersen, Rachel A. ; Kremers, Walter K. ; Cosio, Fernando G. ; Patel, Robin ; Razonable, Raymund R.</creatorcontrib><description>Background. During the contemporary era of antiviral prophylaxis, the impact of delayed-onset primary cytomegalovirus (CMV) disease on the outcome of kidney transplantation is not known. We evaluated the incidence, clinical features, risk factors, and outcomes of CMV disease among high-risk kidney transplant recipients. Methods. The medical records of CMV-seronegative recipients of kidney transplants from CMV-seropositive donors were reviewed. Cox proportional hazards regression was used to identify factors associated with CMV disease and to assess its impact on allograft loss and mortality. Results. None of the 176 CMV-seronegative recipients of kidney transplants from CMV-seropositive donors developed breakthrough CMV disease during a median of 92 days (interquartile range, 90–92 days) of oral ganciclovir or valganciclovir prophylaxis. Thereafter, 51 patients (29%) developed CMV disease at a median of 61 days (interquartile range, 40–143 days) after stopping antiviral prophylaxis. Early-onset bacterial and fungal infection (hazard ratio, 3.61; 95% confidence interval, 1.78–7.33; P<.001) and a Charlson comorbidity index ⩾3 (hazard ratio, 2.21; 95% confidence interval, 1.15–4.22; P=.011) were associated with a higher risk of delayed-onset primary CMV disease, and postrejection antiviral prophylaxis (hazard ratio, 0.29; 95% confidence interval, 0.09–0.94; P=.039) was associated with a lower risk of such CMV disease. A time-dependent Cox regression analysis revealed a statistically significant association between tissue-invasive CMV disease and allograft loss or mortality (hazard ratio, 2.85; 95% confidence interval, 1.22–6.67; P=.016). Conclusion. This study of a large cohort of CMV-seronegative recipients of kidney transplants from CMV-seropositive donors illustrates the ongoing challenge of delayed-onset primary CMV disease and its impact on transplantation outcomes despite antiviral prophylaxis. Better strategies for CMV disease prevention after kidney transplantation are warranted.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1086/528718</identifier><identifier>PMID: 18260785</identifier><identifier>CODEN: CIDIEL</identifier><language>eng</language><publisher>Chicago, IL: The University of Chicago Press</publisher><subject>Adult ; Antivirals ; Articles and Commentaries ; Biological and medical sciences ; Chemoprevention ; Cytomegalovirus ; Cytomegalovirus - isolation & purification ; Cytomegalovirus infections ; Cytomegalovirus Infections - epidemiology ; Cytomegalovirus Infections - prevention & control ; Cytomegalovirus Infections - virology ; Disease risk ; Female ; Fungal diseases ; Fungal infections ; Ganciclovir - analogs & derivatives ; Ganciclovir - therapeutic use ; Graft Rejection - epidemiology ; Humans ; Infectious diseases ; Kidney diseases ; Kidney Transplantation - adverse effects ; Kidney Transplantation - mortality ; Kidneys ; Male ; Medical sciences ; Middle Aged ; Mortality ; Preventive medicine ; Proportional Hazards Models ; Regression analysis ; Risk Factors ; Studies ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the urinary system ; Tissues ; Transplantation ; Transplants & implants ; Viral diseases</subject><ispartof>Clinical infectious diseases, 2008-03, Vol.46 (6), p.840-846</ispartof><rights>Copyright 2008 Infectious Diseases Society of America</rights><rights>2008 by the Infectious Diseases Society of America 2008</rights><rights>2008 INIST-CNRS</rights><rights>Copyright University of Chicago, acting through its Press Mar 15, 2008</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c517t-8df0aac0686278d9e2034dc6ffa5d9e76be1f9a334f48a564d5deb036e4903553</citedby><cites>FETCH-LOGICAL-c517t-8df0aac0686278d9e2034dc6ffa5d9e76be1f9a334f48a564d5deb036e4903553</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/40307105$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/40307105$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>314,776,780,799,27903,27904,57995,58228</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20162423$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18260785$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Arthurs, Supha K.</creatorcontrib><creatorcontrib>Eid, Albert J.</creatorcontrib><creatorcontrib>Pedersen, Rachel A.</creatorcontrib><creatorcontrib>Kremers, Walter K.</creatorcontrib><creatorcontrib>Cosio, Fernando G.</creatorcontrib><creatorcontrib>Patel, Robin</creatorcontrib><creatorcontrib>Razonable, Raymund R.</creatorcontrib><title>Delayed-Onset Primary Cytomegalovirus Disease and the Risk of Allograft Failure and Mortality after Kidney Transplantation</title><title>Clinical infectious diseases</title><addtitle>Clinical Infectious Diseases</addtitle><addtitle>Clinical Infectious Diseases</addtitle><description>Background. During the contemporary era of antiviral prophylaxis, the impact of delayed-onset primary cytomegalovirus (CMV) disease on the outcome of kidney transplantation is not known. We evaluated the incidence, clinical features, risk factors, and outcomes of CMV disease among high-risk kidney transplant recipients. Methods. The medical records of CMV-seronegative recipients of kidney transplants from CMV-seropositive donors were reviewed. Cox proportional hazards regression was used to identify factors associated with CMV disease and to assess its impact on allograft loss and mortality. Results. None of the 176 CMV-seronegative recipients of kidney transplants from CMV-seropositive donors developed breakthrough CMV disease during a median of 92 days (interquartile range, 90–92 days) of oral ganciclovir or valganciclovir prophylaxis. Thereafter, 51 patients (29%) developed CMV disease at a median of 61 days (interquartile range, 40–143 days) after stopping antiviral prophylaxis. Early-onset bacterial and fungal infection (hazard ratio, 3.61; 95% confidence interval, 1.78–7.33; P<.001) and a Charlson comorbidity index ⩾3 (hazard ratio, 2.21; 95% confidence interval, 1.15–4.22; P=.011) were associated with a higher risk of delayed-onset primary CMV disease, and postrejection antiviral prophylaxis (hazard ratio, 0.29; 95% confidence interval, 0.09–0.94; P=.039) was associated with a lower risk of such CMV disease. A time-dependent Cox regression analysis revealed a statistically significant association between tissue-invasive CMV disease and allograft loss or mortality (hazard ratio, 2.85; 95% confidence interval, 1.22–6.67; P=.016). Conclusion. This study of a large cohort of CMV-seronegative recipients of kidney transplants from CMV-seropositive donors illustrates the ongoing challenge of delayed-onset primary CMV disease and its impact on transplantation outcomes despite antiviral prophylaxis. Better strategies for CMV disease prevention after kidney transplantation are warranted.</description><subject>Adult</subject><subject>Antivirals</subject><subject>Articles and Commentaries</subject><subject>Biological and medical sciences</subject><subject>Chemoprevention</subject><subject>Cytomegalovirus</subject><subject>Cytomegalovirus - isolation & purification</subject><subject>Cytomegalovirus infections</subject><subject>Cytomegalovirus Infections - epidemiology</subject><subject>Cytomegalovirus Infections - prevention & control</subject><subject>Cytomegalovirus Infections - virology</subject><subject>Disease risk</subject><subject>Female</subject><subject>Fungal diseases</subject><subject>Fungal infections</subject><subject>Ganciclovir - analogs & derivatives</subject><subject>Ganciclovir - therapeutic use</subject><subject>Graft Rejection - epidemiology</subject><subject>Humans</subject><subject>Infectious diseases</subject><subject>Kidney diseases</subject><subject>Kidney Transplantation - adverse effects</subject><subject>Kidney Transplantation - mortality</subject><subject>Kidneys</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Preventive medicine</subject><subject>Proportional Hazards Models</subject><subject>Regression analysis</subject><subject>Risk Factors</subject><subject>Studies</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the urinary system</subject><subject>Tissues</subject><subject>Transplantation</subject><subject>Transplants & implants</subject><subject>Viral diseases</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkl1rFDEYhQdRbK36D5Qo6N1oPiZfl2X7JVYqWqF4E7Iz79Rss5M1yRTHX2_KLFsQxKsknIeTN-ekqp4T_I5gJd5zqiRRD6p9wpmsBdfkYdljrupGMbVXPUlphTEhCvPH1R5RVGCp-H71-wi8naCrL4YEGX2Obm3jhBZTDmu4tj7cujgmdOQS2ATIDh3KPwB9cekGhR4deh-uo-0zOrHOj3EmPoWYrXd5QkWBiD66boAJXUY7pI23Q7bZheFp9ai3PsGz7XpQfTs5vlyc1ecXpx8Wh-d1y4nMtep6bG2LhRJUqk4DxazpWtH3lpeTFEsgvbaMNX2jLBdNxztYYiag0Zhxzg6qt7PvJoafI6Rs1i614MsgEMZkJGaElpT-C1KsmaZSF_D1X-AqjHEojzCUaC1pmeLerY0hpQi92czhGoLNXWdm7qyAL7du43IN3T22LakAb7aATa31fYmxdWnHUUwEbejd_K9mLoybf1_2YmZWKYe4oxrMsCzfpej1rLuU4ddOt_HGCMkkN2dX381XSq80l6cGsz9SqsCc</recordid><startdate>20080315</startdate><enddate>20080315</enddate><creator>Arthurs, Supha K.</creator><creator>Eid, Albert J.</creator><creator>Pedersen, Rachel A.</creator><creator>Kremers, Walter K.</creator><creator>Cosio, Fernando G.</creator><creator>Patel, Robin</creator><creator>Razonable, Raymund R.</creator><general>The University of Chicago Press</general><general>University of Chicago Press</general><general>Oxford University Press</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7T2</scope><scope>7T7</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20080315</creationdate><title>Delayed-Onset Primary Cytomegalovirus Disease and the Risk of Allograft Failure and Mortality after Kidney Transplantation</title><author>Arthurs, Supha K. ; Eid, Albert J. ; Pedersen, Rachel A. ; Kremers, Walter K. ; Cosio, Fernando G. ; Patel, Robin ; Razonable, Raymund R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c517t-8df0aac0686278d9e2034dc6ffa5d9e76be1f9a334f48a564d5deb036e4903553</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adult</topic><topic>Antivirals</topic><topic>Articles and Commentaries</topic><topic>Biological and medical sciences</topic><topic>Chemoprevention</topic><topic>Cytomegalovirus</topic><topic>Cytomegalovirus - isolation & purification</topic><topic>Cytomegalovirus infections</topic><topic>Cytomegalovirus Infections - epidemiology</topic><topic>Cytomegalovirus Infections - prevention & control</topic><topic>Cytomegalovirus Infections - virology</topic><topic>Disease risk</topic><topic>Female</topic><topic>Fungal diseases</topic><topic>Fungal infections</topic><topic>Ganciclovir - analogs & derivatives</topic><topic>Ganciclovir - therapeutic use</topic><topic>Graft Rejection - epidemiology</topic><topic>Humans</topic><topic>Infectious diseases</topic><topic>Kidney diseases</topic><topic>Kidney Transplantation - adverse effects</topic><topic>Kidney Transplantation - mortality</topic><topic>Kidneys</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Preventive medicine</topic><topic>Proportional Hazards Models</topic><topic>Regression analysis</topic><topic>Risk Factors</topic><topic>Studies</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the urinary system</topic><topic>Tissues</topic><topic>Transplantation</topic><topic>Transplants & implants</topic><topic>Viral diseases</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Arthurs, Supha K.</creatorcontrib><creatorcontrib>Eid, Albert J.</creatorcontrib><creatorcontrib>Pedersen, Rachel A.</creatorcontrib><creatorcontrib>Kremers, Walter K.</creatorcontrib><creatorcontrib>Cosio, Fernando G.</creatorcontrib><creatorcontrib>Patel, Robin</creatorcontrib><creatorcontrib>Razonable, Raymund R.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Arthurs, Supha K.</au><au>Eid, Albert J.</au><au>Pedersen, Rachel A.</au><au>Kremers, Walter K.</au><au>Cosio, Fernando G.</au><au>Patel, Robin</au><au>Razonable, Raymund R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Delayed-Onset Primary Cytomegalovirus Disease and the Risk of Allograft Failure and Mortality after Kidney Transplantation</atitle><jtitle>Clinical infectious diseases</jtitle><stitle>Clinical Infectious Diseases</stitle><addtitle>Clinical Infectious Diseases</addtitle><date>2008-03-15</date><risdate>2008</risdate><volume>46</volume><issue>6</issue><spage>840</spage><epage>846</epage><pages>840-846</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><coden>CIDIEL</coden><abstract>Background. During the contemporary era of antiviral prophylaxis, the impact of delayed-onset primary cytomegalovirus (CMV) disease on the outcome of kidney transplantation is not known. We evaluated the incidence, clinical features, risk factors, and outcomes of CMV disease among high-risk kidney transplant recipients. Methods. The medical records of CMV-seronegative recipients of kidney transplants from CMV-seropositive donors were reviewed. Cox proportional hazards regression was used to identify factors associated with CMV disease and to assess its impact on allograft loss and mortality. Results. None of the 176 CMV-seronegative recipients of kidney transplants from CMV-seropositive donors developed breakthrough CMV disease during a median of 92 days (interquartile range, 90–92 days) of oral ganciclovir or valganciclovir prophylaxis. Thereafter, 51 patients (29%) developed CMV disease at a median of 61 days (interquartile range, 40–143 days) after stopping antiviral prophylaxis. Early-onset bacterial and fungal infection (hazard ratio, 3.61; 95% confidence interval, 1.78–7.33; P<.001) and a Charlson comorbidity index ⩾3 (hazard ratio, 2.21; 95% confidence interval, 1.15–4.22; P=.011) were associated with a higher risk of delayed-onset primary CMV disease, and postrejection antiviral prophylaxis (hazard ratio, 0.29; 95% confidence interval, 0.09–0.94; P=.039) was associated with a lower risk of such CMV disease. A time-dependent Cox regression analysis revealed a statistically significant association between tissue-invasive CMV disease and allograft loss or mortality (hazard ratio, 2.85; 95% confidence interval, 1.22–6.67; P=.016). Conclusion. This study of a large cohort of CMV-seronegative recipients of kidney transplants from CMV-seropositive donors illustrates the ongoing challenge of delayed-onset primary CMV disease and its impact on transplantation outcomes despite antiviral prophylaxis. Better strategies for CMV disease prevention after kidney transplantation are warranted.</abstract><cop>Chicago, IL</cop><pub>The University of Chicago Press</pub><pmid>18260785</pmid><doi>10.1086/528718</doi><tpages>7</tpages></addata></record> |
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| ispartof | Clinical infectious diseases, 2008-03, Vol.46 (6), p.840-846 |
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| source | Jstor Complete Legacy; Oxford University Press Journals All Titles (1996-Current); MEDLINE; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adult Antivirals Articles and Commentaries Biological and medical sciences Chemoprevention Cytomegalovirus Cytomegalovirus - isolation & purification Cytomegalovirus infections Cytomegalovirus Infections - epidemiology Cytomegalovirus Infections - prevention & control Cytomegalovirus Infections - virology Disease risk Female Fungal diseases Fungal infections Ganciclovir - analogs & derivatives Ganciclovir - therapeutic use Graft Rejection - epidemiology Humans Infectious diseases Kidney diseases Kidney Transplantation - adverse effects Kidney Transplantation - mortality Kidneys Male Medical sciences Middle Aged Mortality Preventive medicine Proportional Hazards Models Regression analysis Risk Factors Studies Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the urinary system Tissues Transplantation Transplants & implants Viral diseases |
| title | Delayed-Onset Primary Cytomegalovirus Disease and the Risk of Allograft Failure and Mortality after Kidney Transplantation |
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