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Kidney Transplant-Associated Viral Infection Rates and Outcomes in a Single-Centre Cohort

Background: Opportunistic infections remain a significant cause of morbidity and mortality after kidney transplantation. This retrospective cohort study aimed to assess the incidence and predictors of post-transplant DNA virus infections (CMV, EBV, BKV and JCV infections) in kidney transplant recipi...

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Autores principales: Pullerits, Kairi, Garland, Shona, Rengarajan, Sharmilee, Guiver, Malcolm, Chinnadurai, Rajkumar, Middleton, Rachel J., Chukwu, Chukwuma A., Kalra, Philip A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9695979/
https://www.ncbi.nlm.nih.gov/pubmed/36366504
http://dx.doi.org/10.3390/v14112406
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author Pullerits, Kairi
Garland, Shona
Rengarajan, Sharmilee
Guiver, Malcolm
Chinnadurai, Rajkumar
Middleton, Rachel J.
Chukwu, Chukwuma A.
Kalra, Philip A.
author_facet Pullerits, Kairi
Garland, Shona
Rengarajan, Sharmilee
Guiver, Malcolm
Chinnadurai, Rajkumar
Middleton, Rachel J.
Chukwu, Chukwuma A.
Kalra, Philip A.
author_sort Pullerits, Kairi
collection PubMed
description Background: Opportunistic infections remain a significant cause of morbidity and mortality after kidney transplantation. This retrospective cohort study aimed to assess the incidence and predictors of post-transplant DNA virus infections (CMV, EBV, BKV and JCV infections) in kidney transplant recipients (KTR) at a single tertiary centre and evaluate their impact on graft outcomes. Methods: KTR transplanted between 2000 and 2021 were evaluated. Multivariate logistic regression analysis and Cox proportional hazard analyses were used to identify factors associated with DNA virus infections and their impact on allograft outcomes respectively. A sub-analysis of individual viral infections was also conducted to describe the pattern, timing, interventions, and outcomes of individual infections. Results: Data from 962 recipients were evaluated (Mean age 47.3 ± 15 years, 62% male, 81% white). 30% of recipients (288/962) had infection(s) by one or more of the DNA viruses. Individually, CMV, EBV, BKV and JCV viruses were diagnosed in 13.8%. 11.3%, 8.9% and 4.4% of recipients respectively. Factors associated with increased risk of post-transplant DNA virus infection included recipient female gender, higher number of HLA mismatch, lower baseline estimated glomerular filtration rate (eGFR), CMV seropositive donor, maintenance with cyclosporin (rather than tacrolimus) and higher number of maintenance immunosuppressive medications. The slope of eGFR decline was steeper in recipients with a history of DNA virus infection irrespective of the virus type. Further, GFR declined faster with an increasing number of different viral infections. Death-censored graft loss adjusted for age, gender, total HLA mismatch, baseline eGFR and acute rejection was significantly higher in recipients with a history of DNA virus infection than those without infection (adjusted hazard ratio (aHR, 1.74, 95% CI, 1.08–2.80)). In contrast, dialysis-free survival did not differ between the two groups of recipients (aHR, 1.13, 95% CI, 0.88–1.47). Conclusion: Post-transplant DNA viral infection is associated with a higher risk of allograft loss. Careful management of immunosuppression and close surveillance of at-risk recipients may improve graft outcomes.
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spelling pubmed-96959792022-11-26 Kidney Transplant-Associated Viral Infection Rates and Outcomes in a Single-Centre Cohort Pullerits, Kairi Garland, Shona Rengarajan, Sharmilee Guiver, Malcolm Chinnadurai, Rajkumar Middleton, Rachel J. Chukwu, Chukwuma A. Kalra, Philip A. Viruses Article Background: Opportunistic infections remain a significant cause of morbidity and mortality after kidney transplantation. This retrospective cohort study aimed to assess the incidence and predictors of post-transplant DNA virus infections (CMV, EBV, BKV and JCV infections) in kidney transplant recipients (KTR) at a single tertiary centre and evaluate their impact on graft outcomes. Methods: KTR transplanted between 2000 and 2021 were evaluated. Multivariate logistic regression analysis and Cox proportional hazard analyses were used to identify factors associated with DNA virus infections and their impact on allograft outcomes respectively. A sub-analysis of individual viral infections was also conducted to describe the pattern, timing, interventions, and outcomes of individual infections. Results: Data from 962 recipients were evaluated (Mean age 47.3 ± 15 years, 62% male, 81% white). 30% of recipients (288/962) had infection(s) by one or more of the DNA viruses. Individually, CMV, EBV, BKV and JCV viruses were diagnosed in 13.8%. 11.3%, 8.9% and 4.4% of recipients respectively. Factors associated with increased risk of post-transplant DNA virus infection included recipient female gender, higher number of HLA mismatch, lower baseline estimated glomerular filtration rate (eGFR), CMV seropositive donor, maintenance with cyclosporin (rather than tacrolimus) and higher number of maintenance immunosuppressive medications. The slope of eGFR decline was steeper in recipients with a history of DNA virus infection irrespective of the virus type. Further, GFR declined faster with an increasing number of different viral infections. Death-censored graft loss adjusted for age, gender, total HLA mismatch, baseline eGFR and acute rejection was significantly higher in recipients with a history of DNA virus infection than those without infection (adjusted hazard ratio (aHR, 1.74, 95% CI, 1.08–2.80)). In contrast, dialysis-free survival did not differ between the two groups of recipients (aHR, 1.13, 95% CI, 0.88–1.47). Conclusion: Post-transplant DNA viral infection is associated with a higher risk of allograft loss. Careful management of immunosuppression and close surveillance of at-risk recipients may improve graft outcomes. MDPI 2022-10-29 /pmc/articles/PMC9695979/ /pubmed/36366504 http://dx.doi.org/10.3390/v14112406 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Pullerits, Kairi
Garland, Shona
Rengarajan, Sharmilee
Guiver, Malcolm
Chinnadurai, Rajkumar
Middleton, Rachel J.
Chukwu, Chukwuma A.
Kalra, Philip A.
Kidney Transplant-Associated Viral Infection Rates and Outcomes in a Single-Centre Cohort
title Kidney Transplant-Associated Viral Infection Rates and Outcomes in a Single-Centre Cohort
title_full Kidney Transplant-Associated Viral Infection Rates and Outcomes in a Single-Centre Cohort
title_fullStr Kidney Transplant-Associated Viral Infection Rates and Outcomes in a Single-Centre Cohort
title_full_unstemmed Kidney Transplant-Associated Viral Infection Rates and Outcomes in a Single-Centre Cohort
title_short Kidney Transplant-Associated Viral Infection Rates and Outcomes in a Single-Centre Cohort
title_sort kidney transplant-associated viral infection rates and outcomes in a single-centre cohort
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9695979/
https://www.ncbi.nlm.nih.gov/pubmed/36366504
http://dx.doi.org/10.3390/v14112406
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