Sommerer Claudia, Schröter Iris, Gruneberg Katrin, Schindler Daniela, Morath Christian, Renders Lutz, Einecke Gunilla, Guthoff Martina, Heemann Uwe, Schnitzler Paul, Zeier Martin, Giese Thomas
Nephrology, University Hospital Heidelberg, Im Neuenheimer Feld 162, D-69120, Heidelberg, Germany.
German Centre for Infection Research (DZIF), Heidelberg, Germany.
BMC Nephrol. 2025 Apr 30;26(1):218. doi: 10.1186/s12882-025-04084-5.
Herpes- and polyomaviruses are major opportunistic pathogens after renal transplantation. Despite established guidelines, there is limited data on transplant centers' prophylaxis and monitoring strategies and centers' adherence to these guidelines and their impact on infection rates and patient outcomes.
This multicenter cohort study, conducted by the German Center for Infection Research, included 1035 kidney transplant recipients from five centers (01/2014-02/2021), focusing on herpes- and polyomavirus viremia within the first year and adherence to prophylaxis strategies.
Among 1035 recipients, 26.6% developed herpes- or polyomavirus viremia, predominantly Cytomegalovirus (CMV, 14.3%) and BK-virus (BKV, 13.2%). BKV monitoring frequency was below guideline recommendations. Deviations from guidelines were most common in CMV D-/R- (34.6% with prophylaxis) and D-/R + groups (37.3% without prophylaxis), doubling CMV-incidence in D-/R+ (28.9% vs. 12.5%, p < 0.01). In D+/R - group, six-month-prophylaxis reduced CMV-incidence compared to three months (22.5% vs. 38.4%, p < 0.01). Breakthrough-viremia was most commonly observed in D+/R - recipients who received a six-month-prophylaxis. Overall, viremia was associated with higher incidence of acute rejection (31.9% vs. 17.6%, p < 0.01), with most CMV-viremias occurring after rejection. CMV-viremia was associated with a higher risk of bacterial infection (HR = 1.77, [1.03;3.02]). Other herpesviruses were associated with a quadrupled risk for fungal infection (HR = 4.34, [1.03;18.30]) and the non-administration of CMV-prophylaxis (HR = 0.22, [0.11;0.47]). Graft survival and mortality were unaffected within the first year.
Clinical variability in guideline implementation drives high herpes- and polyomavirus infection rates with suboptimal outcomes. Future guidelines should focus on differentiated risk stratification to address breakthrough, post-prophylaxis, and post-rejection CMV, and include protocols for the early detection of secondary infections.
疱疹病毒和多瘤病毒是肾移植后主要的机会性病原体。尽管已有既定指南，但关于移植中心的预防和监测策略以及各中心对这些指南的遵守情况及其对感染率和患者预后的影响的数据有限。
这项由德国感染研究中心开展的多中心队列研究纳入了来自五个中心的1035名肾移植受者（2014年1月至2021年2月），重点关注第一年的疱疹病毒和多瘤病毒血症以及对预防策略的遵守情况。
在1035名受者中，26.6%发生了疱疹病毒或多瘤病毒血症，主要是巨细胞病毒（CMV，14.3%）和BK病毒（BKV，13.2%）。BKV监测频率低于指南建议。与指南的偏差在CMV D-/R-（34.6%接受预防）和D-/R+组（37.3%未接受预防）中最为常见，使D-/R+组的CMV发病率翻倍（28.9%对12.5%，p<0.01）。在D+/R-组中，与三个月预防相比，六个月预防降低了CMV发病率（22.5%对38.4%，p<0.01）。突破性病毒血症最常出现在接受六个月预防的D+/R-受者中。总体而言，病毒血症与急性排斥反应的较高发生率相关（31.9%对17.6%，p<0.01），大多数CMV病毒血症发生在排斥反应之后。CMV病毒血症与细菌感染的较高风险相关（HR=1.77，[1.03；3.02]）。其他疱疹病毒与真菌感染风险增加四倍（HR=4.34，[1.
