Risk of CMV Infection and Seroconversion in Kidney Transplantation in adults – an analysis of induction over time.

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Body of Abstract:
Background: CMV is one of the most consequential infections affecting kidney transplant recipients, leading to higher risk of graft loss, morbidity and mortality1. There are multiple risk factors for CMV seroconversion including donor/recipient serological status, anti-thymocyte globulin (ATG) induction and mycophenolate maintenance immunosuppression2,3. This study evaluates induction regimens, among other risk factors, over the past two and the half decades.

Methods: UNOS database was analyzed from year 2000 to 2024. Cox regression was used for the occurrence of CMV IgM+ from IgG- or IgG+ (N=206,113). Logistic regression was done for seroconversion analysis (IgM-/IgG- to IgM+/IgG+) (N = 45,783).

Results: Recipient who were older, men, of African American or Hispanic ethnicity/group, with higher cPRA and longer wait listing had higher odds of (primary and secondary) infection and seroconversion due to CMV infection. Alemtuzumab correlated with higher odds of infection but lower seroconversion (HR 1.18 95%CI[1.09-1.26]; p<0.001 and OR 0.89 95%[0.80-0.98]; p=0.027 respectively) than thymoglobulin. Seroconversion was less likely with IL2Ra induction (OR 0.86 95%[0.78-0.95]; p=0.003) and infection less likely with dual induction ATG+IL2 Receptor antagonist (HR 0.72 95%[0.60-0.86]; p<0.001). Seroconversion was less likely for recipients transplant between 2012 and 2024 compared to 2000 until 2011 (OR 0.91 95%[0.84-0.99]; p=0.035). Conclusions: While primary and secondary CMV infections seem to be similar over time, the risk of seroconversion appears to have improved in the past decade, possibly due to the adoption of better prophylaxis regimens. 1- Selvey, L.A., Lim, W.H., Boan, P. et al. Cytomegalovirus viraemia and mortality in renal transplant recipients in the era of antiviral prophylaxis. Lessons from the western Australian experience. BMC Infect Dis 17, 501 (2017). https://doi.org/10.1186/s12879-017-2599-y 2- Luan FL, Samaniego M, Kommareddi M, Park JM, Ojo AO. Choice of induction regimens on the risk of cytomegalovirus infection in donor-positive and recipient-negative kidney transplant recipients. Transpl Infect Dis. 2010 Dec;12(6):473-9. doi: 10.1111/j.1399-3062.2010.00532.x. PMID: 20576019; PMCID: PMC3831513. 3- Sarmiento JM, Dockrell DH, Schwab TR, Munn SR, Paya CV. Mycophenolate mofetil increases cytomegalovirus invasive organ disease in renal transplant patients. Clin Transplant. 2000 Apr;14(2):136-8. doi: 10.1034/j.1399-0012.2000.140206.x. PMID: 10770418.