Kidney Week

Abstract: FR-PO867

Cytomegalovirus Serostatus and Living Donor Kidney Transplant Outcomes in the Era of Routine CMV Prophylactic and Preemptive Therapy

Session Information

• Transplantation: Translational and Transplant Pathology
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1802 Transplantation: Clinical

Authors

• Leeaphorn, Napat, Renal Transplant Program, University of Missouri-Kansas City School of Medicine/Saint Luke's Health System, Kansas City, Missouri, United States

Napat Leeaphorn,

• Thamcharoen, Natanong, Transplant Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States

Natanong Thamcharoen,

• Garg, Neetika, University of Wisconsin-Madison, Madison, Wisconsin, United States

Neetika Garg,

• Chon, Woojin James, Renal Transplant Program, University of Missouri-Kansas City School of Medicine/Saint Luke's Health System, Kansas City, Missouri, United States

Woojin James Chon,

• Cummings, Lee S., Renal Transplant Program, University of Missouri-Kansas City School of Medicine/Saint Luke's Health System, Kansas City, Missouri, United States

Lee S. Cummings,

• Pavlakis, Martha, Transplant Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States

Martha Pavlakis,

Background

The impact of CMV serostatus on living donor kidney transplant outcomes in an era when CMV prophylactic and preemptive strategies are used routinely has never been examined.

Methods

Using UNOS/OPTN data, adult patients with first living donor kidney transplant between 2010 and 2015 were stratified into 4 groups: D-/R-, D+/R-, D+/R+, and D-/R+. Death-censored graft survival, all-cause mortality and cumulative incidence of rejection at 1-year were examined using D-/R- as a reference group.

Results

A total of 28,730 recipients were included: 4,972 (17.3%) in D+/R-, 7,404 (25.8%) in D-/R-, 10,233 (35.6%) in D+/R+, and 6,121 (21.3%) in D-/R+ group. In the multivariable analysis, D+/R- was associated with an increased risk of graft failure (HR=1.18, P=0.049) when compared to D-/R-. There was also an increased risk of graft failure in D+/R+ when compared to D-/R- (HR=1.09, P=0.021). CMV serostatus did not have any statistically significant effects on all-cause mortality or acute rejection at 1 year.

Conclusion

In living donor kidney transplantation, CMV mismatch (D+/R-) is not an independent risk factor for patient mortality in the era of effective prophylactic and preemptive strategies. D+/R- and D+/R+ serostatus have a slightly negative impact on graft survival. These findings can be informative and used for patient counseling before undergoing living donor kidney transplantation.