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

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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.

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Funding

Research reported in this publication was supported by the National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health under award number 5T32AI100851 (MHM, BDA) and National Institute on Aging (NIA) of the National Institutes of Health, Duke Pepper Older Americans Independence Center P30AG028716 (KES). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This research was also supported by an internal grant from the Duke Transplant Center (MHM).

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Authors and Affiliations

  1. Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA

    Marion Hemmersbach-Miller & Barbara D. Alexander

  2. Duke Clinical Research Institute, Durham, NC, USA

    Marion Hemmersbach-Miller

  3. Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA

    Carl F. Pieper

  4. Division of Geriatrics, Duke University Medical Center, Durham, NC, USA

    Kenneth E. Schmader

  5. GRECC, Durham VA, Durham, NC, USA

    Kenneth E. Schmader

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  1. Marion Hemmersbach-Miller
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  2. Barbara D. Alexander
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Correspondence to Marion Hemmersbach-Miller.

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The study was approved by the Duke University Health System Institutional Review Board for Clinical Investigation (Pro00076804). A waiver for informed consent was granted.

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Hemmersbach-Miller, M., Alexander, B.D., Pieper, C.F. et al. Age matters: older age as a risk factor for CMV reactivation in the CMV serostatus–positive kidney transplant recipient. Eur J Clin Microbiol Infect Dis 39, 455–463 (2020). https://doi.org/10.1007/s10096-019-03744-3

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