Hidaka Sumi, Tanabe Kazunari, Kobayashi Shuzo
Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan.
Kidney Transplant and Robotic Surgery Center, Shonan Kamakura General Hospital, Kanagawa, Japan.
Ren Fail. 2025 Dec;47(1):2491658. doi: 10.1080/0886022X.2025.2491658. Epub 2025 Apr 22.
Cytomegalovirus (CMV) infection is a frequent complication following kidney transplantation that affects transplant outcomes. This study aimed to (i) estimate the 12-month cumulative incidence of CMV antigenemia (AG) in adult kidney transplant recipients not receiving antiviral prophylaxis, (ii) identify the risk factors for CMV AG, and (iii) assess the impact of CMV AG on transplant outcomes. This study included 128 living donor kidney recipients (aged ≥20 years) who underwent transplantation between 2012 and 2020. The mean recipient age was 52.8 ± 13.0 years. The overall positive CMV AG rates were 10.9%, 35.9%, 45.3%, 53.1%, and 59.4% (95% confidence interval (CI), 50.9-67.9) at 1, 2, 3, 6, and 12 months posttransplantation, respectively. The 12-month incidence rates in D-/R-, D-/R+, D+/R+, and D+/R - were 0%, 25.0%, 62.2%, and 81.3%, respectively. Multivariable analysis revealed that the risk of CMV AG increased with a stepwise increase in CMV serostatus risk category (hazard ratio (HR), 2.65; 95% CI, 1.66-4.21; < .001) and recipient age (HR, 1.37 per 10-year increase; 95% CI, 1.14-1.65; < .001). Positive CMV AG was associated with an increased risk of antibody-mediated rejection (HR, 21.40; 95% CI, 2.59-176.2; = .005) and lower estimated glomerular filtration rate ( = .026). The risk of CMV AG is highest within the first 3 months posttransplant and persists for approximately 7-8 months in D + recipients. These findings underscore the importance of regular CMV monitoring for at least 6 months posttransplantation, particularly in centers employing preemptive therapy.
巨细胞病毒（CMV）感染是肾移植后常见的并发症，会影响移植效果。本研究旨在：（i）估算未接受抗病毒预防的成年肾移植受者12个月时CMV抗原血症（AG）的累积发病率；（ii）确定CMV AG的危险因素；（iii）评估CMV AG对移植效果的影响。本研究纳入了2012年至2020年间接受移植的128例活体供肾受者（年龄≥20岁）。受者平均年龄为52.8±13.0岁。移植后1、2、3、6和12个月时，CMV AG总体阳性率分别为10.9%、35.9%、45.3%、53.1%和59.4%（95%置信区间（CI），50.9 - 67.9）。D - /R - 、D - /R + 、D + /R + 和D + /R - 组的12个月发病率分别为0%、25.0%、62.2%和81.3%。多变量分析显示，CMV AG风险随CMV血清学状态风险类别逐步增加而升高（风险比（HR），2.65；95% CI，1.66 - 4.21；P <.001）以及受者年龄增加而升高（HR，每增加10岁为1.37；95% CI，1.14 - 1.65；P <.001）。CMV AG阳性与抗体介导的排斥反应风险增加相关（HR，21.40；95% CI，2.59 - 176.2；P =.005）以及估计肾小球滤过率降低相关（P =.026）。CMV AG风险在移植后前3个月内最高，且在D + 受者中持续约7 - 8个月。这些发现强调了移植后至少6个月进行定期CMV监测的重要性，特别是在采用抢先治疗的中心。
