Impact of Induction Agents on CMV Infection and Seroconversion in Pediatric Renal Transplant Recipients, an Analysis of UNOS Data from 2000-2024

Authors:
Alejandro Navarro, Geovani Faddoul, Jason Perlmutter, Jorge Ortiz, Meng-Hao Li, Naoru Koizumi

Body of Abstract:
Background: Cytomegalovirus (CMV) infection affecting kidney transplant recipients can lead to graft failure, increased morbidity, and mortality 1. Although efforts have focused on identifying risk factors for CMV infections, large data analyses are centered on the adult population2. This assessment examines induction regimens and risk factors associated with primary and secondary CMV infections, including seroconversion, in pediatric kidney transplants.

Methods: The UNOS database was analyzed from year 2000 to 2024. Cox regression evaluated the occurrence of CMV IgM+ from IgG- or IgG+ (N=10,591). Logistic regression examined seroconversion analysis (IgM-/IgG- to IgM+/IgG+) (N = 7,207)

Results: Prednisone maintenance correlated with higher infection and seroconversion (HR 1.32 95%CI[1.03-1.69]; p=0.028 and OR 1.53 95%CI[1.25 – 1.89]; p=<0.001 respectively). Seroconversion was less likely with dual induction anti-thymocyte globulin (ATG) + IL2 receptor antagonist (IL2Ra) (OR 0.41 95%[0.22-0.77]; p=0.006). Seroconversion was less likely for recipients transplanted between 2012-2024 compared to the previous era (OR 0.69 95%[0.57 - 0.82]; p=<0.001). CMV negative to positive transplant had the highest odds of infection and seroconversion (HR 2.7 95%[2.10 - 3.71]; p=<0.001 and OR 2.7 95%[2.27 - 3.44]; p=<0.001 respectively). Conclusion: Alemtuzumab and IL2Ra did not correlate with better CMV infection of seroconversion compared to ATG in pediatric kidney transplants. Improvement in seroconversion rates over the last decade may be attributed to improved prophylactic and induction protocols. 1. Balani SS, Sadiq S, Jensen CJ, Kizilbash SJ. Prevention and management of CMV infection in pediatric solid organ transplant recipients. Front Pediatr. 2023 Feb 20;11:1098434. doi: 10.3389/fped.2023.1098434. PMID: 36891229; PMCID: PMC9986459 2. Al Atbee MYN, Tuama HS. Cytomegalovirus infection after renal transplantation. J Med Life. 2022 Jan;15(1):71-77. doi: 10.25122/jml-2021-0209. PMID: 35186139; PMCID: PMC8852648.