AFTER PROPHYLAXIS ENDS: CMV INFECTION DYNAMICS IN INDIAN RENAL TRANSPLANT PATIENTS

Introduction:

Renal transplantation has become the most effective means of rehabilitating patients with ESRD. Cytomegalovirus(CMV), an important pathogen in renal transplant recipients, causes direct and indirect effects. CMV infection after renal transplant is associated with a high burden of healthcare utilization and cost. Valganciclovir prophylaxis for CMV is now widely used and has been associated with reductions in CMV disease, mortality and graft rejection. Despite these measures, some may develop CMV infection after the cessation of prophylaxis.Understanding post prophylaxis CMV infection is crucial because it can lead to serious complications potentially impacting the long-term survival of the graft and the patient. The aim of this research is to characterize the burden of post prophylaxis CMV infections in the kidney transplant cohort, study the clinical characteristics and course of such CMV infection and analyse its risk factors and its impact on graft and patient survival in Indian patients.

Methods:

Patients who are satisfying the inclusion criteria were included in the study. All patients received triple immunosuppression including steroid, CNI and MMF. The deceased donor recipients and live unrelated renal transplant recipients received anti-thymocyte antiglobulin [ATG] as induction agent and others received basiliximab. All Patients received Oral valganciclovir (dose adjusted based on eGFR) prophylaxis for 6 months and cotrimoxazole for 1 year. After completion of valganciclovir prophylaxis, patients were followed up monthly for 6 months to look for symptoms or signs of CMV infection. CMV infection (CMVI) is defined by isolation of CMV virus or detection of viral proteins or nucleic acid in any body fluid or tissue specimen. CMV syndrome is defined by the CMVI with presence of fever/malaise with leukopenia and /or thrombocytopenia and/or elevation of hepatic transaminases. CMV disease is defined by combination of CMVI with signs/symptoms. Post prophylaxis CMVI/disease is defined by CMVI/disease with onset within 6 months after completion of antiviral prophylaxis. CMV DNA PCR and other relevant investigations were done at 0, 3, 6 months after the completion of 6 months of valganciclovir prophylaxis or whenever a suspicion of CMVI arises within 6 months of completion of prophylaxis. Those with CMVI were treated as per institutional protocol.

Results:

The total patients included in the study were 81.All were D+/R+.

Among them 28 developed CMV infection (34.5%). Males were 8 and females were 20.

78% of the patients underwent deceased donor renal transplant. 80% of the patients developed CMV infection within 3 months of completion of prophylaxis with valganciclovir. Among the CMV disease, most common involved organ is gastrointestinal tract and most common symptom is abdominal pain.

 Leukopenia is present in 72.5% of patients. Anti-rejection therapy is the most important risk factor for development of CMVI. The mean creatinine at the end of study in CMV positive patients is 4.26 mg/dl and in CMV negative patients is 3.78 mg/dl. 11 patients expired during the follow-up but none were CMV positive.

Conclusions:

In our study,the incidence of post prophylaxis CMV is 34.5% and most of them were asymptomatic. Almost 3/4th of the patients had leukopenia. The CMV infection has negatively affected the graft survival and has no impact on the patient survival.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.