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. 2020 Mar;39(3):455-463.
doi: 10.1007/s10096-019-03744-3. Epub 2019 Nov 22.

Age matters: older age as a risk factor for CMV reactivation in the CMV serostatus-positive kidney transplant recipient

Marion Hemmersbach-Miller  1   2 , Barbara D Alexander  3 , Carl F Pieper  4 , Kenneth E Schmader  5   6
Affiliations

Age matters: older age as a risk factor for CMV reactivation in the CMV serostatus-positive kidney transplant recipient

Marion Hemmersbach-Miller et al. Eur J Clin Microbiol Infect Dis. 2020 Mar.

Abstract

Evaluate risk factors for cytomegalovirus (CMV) reactivation during the first year after kidney transplantation in the CMV-seropositive older recipient. Retrospective single-center study. Between 2011 and 2015, 91 patients ≥ 65 years received a kidney transplant; these were matched with 91 controls, aged 40-60. Risk of CMV reactivation in the CMV-seropositive recipients was analyzed. Sixty-three older and 54 younger recipients were included; 50% had received CMV-directed prophylaxis. CMV reactivation was significantly more frequent in the older group (71.4% vs 44.4%, p = 0.003) and occurred earlier (p = 0.003). A multivariate model showed that only age was associated with CMV reactivation (OR 2.48, p = 0.03). After excluding patients that received thymoglobulin, older age group remained the only risk factor of CMV reactivation (OR 3.81, p = 0.014). Recurrent event analysis showed that the older cohort had an HR of 1.94 (p = 0.01) of CMV viremia; there was significant episode-cohort interaction (p < 0.01). While the older group had a higher risk of infection (HR = 2.43), after the initial episode the relative hazards were approximately equal (HR = 1.08, at period 2). This suggests that it is key to specifically avoid the first episode of reactivation. Universal prophylaxis or a hybrid prophylaxis model should be considered in the CMV-seropositive kidney transplant recipient aged ≥ 65 years.

Keywords: Cytomegalovirus; Infection; Kidney transplantation; Older adults.

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Conflict of interest statement

Conflict of interests: The authors declare that they have no conflict of interests.

Figures

Fig. 1.
Fig. 1.
A. Number of patients with any CMV viremia in the older versus younger cohort. B. Number of episodes of CMV viremia in the first year after kidney transplantation in the older versus younger cohort.
Fig. 2.
Fig. 2.. Time to first episode of CMV viremia. p=0.003.
Fig. 3.
Fig. 3.. Marginal models. Episode-cohort interaction. First three episodes.
A. All patients. B. Excludes patients that received thymoglobulin in the first year after kidney transplantation. Cohort 0 (blue): 40-60 years of age. Cohort 1 (red): aged ≥ 65 years. Hz: hazard ratio. While the older group had a higher risk of CMV reactivation, after the initial episode the relative hazards of were approximately equal between the age groups (at period 2).
Fig. 3.
Fig. 3.. Marginal models. Episode-cohort interaction. First three episodes.
A. All patients. B. Excludes patients that received thymoglobulin in the first year after kidney transplantation. Cohort 0 (blue): 40-60 years of age. Cohort 1 (red): aged ≥ 65 years. Hz: hazard ratio. While the older group had a higher risk of CMV reactivation, after the initial episode the relative hazards of were approximately equal between the age groups (at period 2).
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