Kidney Transplant-Associated Viral Infection Rates and Outcomes in a Single-Centre Cohort
Background: Opportunistic infections remain a significant cause of morbidity and mortality after kidney transplantation. This retrospective cohort study aimed to assess the incidence and predictors of post-transplant DNA virus infections (CMV, EBV, BKV and JCV infections) in kidney transplant recipi...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-10-01
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| Series: | Viruses |
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| Online Access: | https://www.mdpi.com/1999-4915/14/11/2406 |
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| author | Kairi Pullerits Shona Garland Sharmilee Rengarajan Malcolm Guiver Rajkumar Chinnadurai Rachel J. Middleton Chukwuma A. Chukwu Philip A. Kalra |
| author_facet | Kairi Pullerits Shona Garland Sharmilee Rengarajan Malcolm Guiver Rajkumar Chinnadurai Rachel J. Middleton Chukwuma A. Chukwu Philip A. Kalra |
| author_sort | Kairi Pullerits |
| collection | DOAJ |
| description | Background: Opportunistic infections remain a significant cause of morbidity and mortality after kidney transplantation. This retrospective cohort study aimed to assess the incidence and predictors of post-transplant DNA virus infections (CMV, EBV, BKV and JCV infections) in kidney transplant recipients (KTR) at a single tertiary centre and evaluate their impact on graft outcomes. Methods: KTR transplanted between 2000 and 2021 were evaluated. Multivariate logistic regression analysis and Cox proportional hazard analyses were used to identify factors associated with DNA virus infections and their impact on allograft outcomes respectively. A sub-analysis of individual viral infections was also conducted to describe the pattern, timing, interventions, and outcomes of individual infections. Results: Data from 962 recipients were evaluated (Mean age 47.3 ± 15 years, 62% male, 81% white). 30% of recipients (288/962) had infection(s) by one or more of the DNA viruses. Individually, CMV, EBV, BKV and JCV viruses were diagnosed in 13.8%. 11.3%, 8.9% and 4.4% of recipients respectively. Factors associated with increased risk of post-transplant DNA virus infection included recipient female gender, higher number of HLA mismatch, lower baseline estimated glomerular filtration rate (eGFR), CMV seropositive donor, maintenance with cyclosporin (rather than tacrolimus) and higher number of maintenance immunosuppressive medications. The slope of eGFR decline was steeper in recipients with a history of DNA virus infection irrespective of the virus type. Further, GFR declined faster with an increasing number of different viral infections. Death-censored graft loss adjusted for age, gender, total HLA mismatch, baseline eGFR and acute rejection was significantly higher in recipients with a history of DNA virus infection than those without infection (adjusted hazard ratio (aHR, 1.74, 95% CI, 1.08–2.80)). In contrast, dialysis-free survival did not differ between the two groups of recipients (aHR, 1.13, 95% CI, 0.88–1.47). Conclusion: Post-transplant DNA viral infection is associated with a higher risk of allograft loss. Careful management of immunosuppression and close surveillance of at-risk recipients may improve graft outcomes. |
| first_indexed | 2024-03-09T18:33:57Z |
| format | Article |
| id | doaj.art-29704442b7e049b29e207eccf8e3a3f6 |
| institution | Directory Open Access Journal |
| issn | 1999-4915 |
| language | English |
| last_indexed | 2024-03-09T18:33:57Z |
| publishDate | 2022-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Viruses |
| spelling | doaj.art-29704442b7e049b29e207eccf8e3a3f62023-11-24T07:16:41ZengMDPI AGViruses1999-49152022-10-011411240610.3390/v14112406Kidney Transplant-Associated Viral Infection Rates and Outcomes in a Single-Centre CohortKairi Pullerits0Shona Garland1Sharmilee Rengarajan2Malcolm Guiver3Rajkumar Chinnadurai4Rachel J. Middleton5Chukwuma A. Chukwu6Philip A. Kalra7Department of Undergraduate Medicine, University of Manchester, Oxford Road, Manchester M13 9PL, UKDepartment of Undergraduate Medicine, University of Manchester, Oxford Road, Manchester M13 9PL, UKDepartment of Nephrology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford M6 8HD, UKDepartment of Virology Manchester, University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UKDepartment of Nephrology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford M6 8HD, UKDepartment of Nephrology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford M6 8HD, UKDepartment of Nephrology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford M6 8HD, UKDepartment of Nephrology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford M6 8HD, UKBackground: Opportunistic infections remain a significant cause of morbidity and mortality after kidney transplantation. This retrospective cohort study aimed to assess the incidence and predictors of post-transplant DNA virus infections (CMV, EBV, BKV and JCV infections) in kidney transplant recipients (KTR) at a single tertiary centre and evaluate their impact on graft outcomes. Methods: KTR transplanted between 2000 and 2021 were evaluated. Multivariate logistic regression analysis and Cox proportional hazard analyses were used to identify factors associated with DNA virus infections and their impact on allograft outcomes respectively. A sub-analysis of individual viral infections was also conducted to describe the pattern, timing, interventions, and outcomes of individual infections. Results: Data from 962 recipients were evaluated (Mean age 47.3 ± 15 years, 62% male, 81% white). 30% of recipients (288/962) had infection(s) by one or more of the DNA viruses. Individually, CMV, EBV, BKV and JCV viruses were diagnosed in 13.8%. 11.3%, 8.9% and 4.4% of recipients respectively. Factors associated with increased risk of post-transplant DNA virus infection included recipient female gender, higher number of HLA mismatch, lower baseline estimated glomerular filtration rate (eGFR), CMV seropositive donor, maintenance with cyclosporin (rather than tacrolimus) and higher number of maintenance immunosuppressive medications. The slope of eGFR decline was steeper in recipients with a history of DNA virus infection irrespective of the virus type. Further, GFR declined faster with an increasing number of different viral infections. Death-censored graft loss adjusted for age, gender, total HLA mismatch, baseline eGFR and acute rejection was significantly higher in recipients with a history of DNA virus infection than those without infection (adjusted hazard ratio (aHR, 1.74, 95% CI, 1.08–2.80)). In contrast, dialysis-free survival did not differ between the two groups of recipients (aHR, 1.13, 95% CI, 0.88–1.47). Conclusion: Post-transplant DNA viral infection is associated with a higher risk of allograft loss. Careful management of immunosuppression and close surveillance of at-risk recipients may improve graft outcomes.https://www.mdpi.com/1999-4915/14/11/2406kidney transplantationCMV viremiaEBV viremiaBKV viremiaJCV viremia |
| spellingShingle | Kairi Pullerits Shona Garland Sharmilee Rengarajan Malcolm Guiver Rajkumar Chinnadurai Rachel J. Middleton Chukwuma A. Chukwu Philip A. Kalra Kidney Transplant-Associated Viral Infection Rates and Outcomes in a Single-Centre Cohort Viruses kidney transplantation CMV viremia EBV viremia BKV viremia JCV viremia |
| title | Kidney Transplant-Associated Viral Infection Rates and Outcomes in a Single-Centre Cohort |
| title_full | Kidney Transplant-Associated Viral Infection Rates and Outcomes in a Single-Centre Cohort |
| title_fullStr | Kidney Transplant-Associated Viral Infection Rates and Outcomes in a Single-Centre Cohort |
| title_full_unstemmed | Kidney Transplant-Associated Viral Infection Rates and Outcomes in a Single-Centre Cohort |
| title_short | Kidney Transplant-Associated Viral Infection Rates and Outcomes in a Single-Centre Cohort |
| title_sort | kidney transplant associated viral infection rates and outcomes in a single centre cohort |
| topic | kidney transplantation CMV viremia EBV viremia BKV viremia JCV viremia |
| url | https://www.mdpi.com/1999-4915/14/11/2406 |
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