Risk Assessment of Cytomegalovirus Reactivation After Kidney Transplantation Under a Universal Preemptive Strategy in the Era of Intravenous Immunoglobulin-Based Desensitization Therapy.

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.