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Войти в исследования International journal of urology : official journal of the Japanese Urological Association · 2026
Risk Assessment of Cytomegalovirus Reactivation After Kidney Transplantation Under a Universal Preemptive Strategy in the Era of Intravenous Immunoglobulin-Based Desensitization Therapy.
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Kijima Yu, Hirai Toshihito, Nozaki Shuhei, Yagisawa Takafumi, Saito Ayaka, Unagami Kohei, Omoto Kazuya, Shimizu Tomokazu, Takagi Toshio, Ishida Hideki
Аннотация
BACKGROUND: Cytomegalovirus (CMV) infection remains a key opportunistic complication after kidney transplantation. We evaluated risk factors for CMV reactivation in a universal preemptive strategy for the recent patient cohort including immunologically crossmatch positive high-risk recipients who underwent Intravenous Immunoglobulin (IVIG)-based desensitization with rituximab (Rit).
METHODS: In this retrospective cohort study, 395 adult KTx recipients treated between 2019 and 2021 were enrolled. All 395 recipients were divided into 3 groups as follows: group 1 receiving IVIG (+)/Rit (+), n = 32 (8.1%); group 2 Rit (+) only, n = 270 (68.6%); group 3 receiving none, n = 93 (23.5%). The purpose of this study is to examine the influence of immunosuppressants including IVIG and/or Rit on CMV infection.
RESULTS: Totally, CMV antigenemia was observed in 51 of 395 recipients (12.9%). Among them, 8 out of 32 recipients in group 1 (25.0%) showed CMV antigenemia, 29 out of 270 recipients in group 2 (10.7%), and 14 out of 93 recipients in group 3 (15.1%). There was a higher tendency of CMV antigenemia incidence in group 1, compared to groups 2 and 3, although not statistical significance. Univariate and multivariate logistic regression identified pre-transplant CMV-IgG seronegativity (OR 2.58; 95% CI 1.36-4.88; p = 0.004) and Immunological high-risk (OR 2.56; 95% CI 1.10-5.95; p = 0.038) as independent risk factors for CMV reactivation.
CONCLUSIONS: Seronegative status and immunosuppression against high immunological risk increased reactivation risk. Prophylactic treatment could be useful to prevent postoperative early complication in highly sensitized recipients using IVIG.
METHODS: In this retrospective cohort study, 395 adult KTx recipients treated between 2019 and 2021 were enrolled. All 395 recipients were divided into 3 groups as follows: group 1 receiving IVIG (+)/Rit (+), n = 32 (8.1%); group 2 Rit (+) only, n = 270 (68.6%); group 3 receiving none, n = 93 (23.5%). The purpose of this study is to examine the influence of immunosuppressants including IVIG and/or Rit on CMV infection.
RESULTS: Totally, CMV antigenemia was observed in 51 of 395 recipients (12.9%). Among them, 8 out of 32 recipients in group 1 (25.0%) showed CMV antigenemia, 29 out of 270 recipients in group 2 (10.7%), and 14 out of 93 recipients in group 3 (15.1%). There was a higher tendency of CMV antigenemia incidence in group 1, compared to groups 2 and 3, although not statistical significance. Univariate and multivariate logistic regression identified pre-transplant CMV-IgG seronegativity (OR 2.58; 95% CI 1.36-4.88; p = 0.004) and Immunological high-risk (OR 2.56; 95% CI 1.10-5.95; p = 0.038) as independent risk factors for CMV reactivation.
CONCLUSIONS: Seronegative status and immunosuppression against high immunological risk increased reactivation risk. Prophylactic treatment could be useful to prevent postoperative early complication in highly sensitized recipients using IVIG.