COMPLICATIONS - INFECTIONS

M.A. Ilham¹, M. Stephens¹, E. Glyn¹, J. Sinha², A. Asderakis^1
1Transplant Unit, University Hospital of Wales, 4XW/UNITED KINGDOM, ²Specialist Virology Centre, University Hospital of Wales, 4XW/UNITED KINGDOM

Body: Introduction Solid organ transplant recipients receiving immunosuppressives are susceptible to opportunistic infections. Cytomegalovirus (CMV) infection has a detrimental effect on these patients. Antiviral prophylaxis has helped in reducing the rate of CMV and played a significant role in curtailing their detrimental effects. Induction with lymphocyte depleting agents has been traditionally implicated in the emergence of CMV infection. Aim Investigate the incidence and risk factors for CMV disease in renal and simultaneous renal and pancreas transplant recipient who received oral valganciclovir prophylaxis with particular emphasis to the impact of induction treatment. Patients and results 200 recipients of kidney or simultaneous kidney and pancreas transplants between January 2004 and December 2007 received three month oral valganciclovir prophylaxis following transplantation. 27% of patients (including all patients with SPK) received ATG induction (5 doses of 1.25 mg/kg). 28 patients developed CMV disease despite valganciclovir prophylaxis. Univariate analysis for potential risk factors for developing CMV disease vs. CMV disease free recipients showed that recipient age (46 vs. 48 years p=0.57), donor female sex (60.7% vs. 54.7% p=0.68), recipient female sex (35.7% vs. 36.6%, p=1), recipient ABO blood group p=0.66, total HLA mismatches (2 vs. 3, p=0.39), and HLA DR mismatches (0 vs. 1 p=0.08) were not a significant risk factor for developing CMV disease. Donor age (57 vs. 48 years p=0.001), donor positive CMV serostatus (92.9% vs. 64.3% p=0.002), negative recipient CMV pretransplant serostatus (82.1% vs. 32.6% p<0.001), and no ATG induction (92.9% vs 69.8% p=0.01) were significant for development of CMV disease. Regression model including only the significant risk factors identified in the univariate analysis revealed that only donor positive and recipient negative pretransplant CMV serostatus remains a significant risk factor for developing CMV disease in spite of prophylaxis (HR 0.249, SE 0.047, p<0.001) Conclusion Donor and recipient pretransplant serostatus remains a significant risk factor for developing CMV disease posttransplantation in spite of employing oral valganciclovir prophylaxis regimes. ATG induction at least in the regime used in this population and HLA DR and total HLA mismatches, however, are not a risk factor in this clinical setting.

Disclosure: All authors have declared no conflicts of interest.