Abstract: SA-PO1126
Post-Transplant Lymphopenia as a Dynamic Predictor of Cytomegalovirus Infection: A Time-Dependent Risk Analysis and Adaptive Monitoring Simulation
Session Information
- Transplantation: Clinical - Infectious Diseases
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Marchini, Montserrat, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico
- Camacho Murillo, Luis Agustín, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico
- Zuñiga Gonzalez, Erick Yasar, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico
- Morales-Buenrostro, Luis E., Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico
Background
Post-transplant lymphopenia is a frequent complication with potential implications for opportunistic infection susceptibility. Its dynamic association with cytomegalovirus (CMV) infection has not been fully characterized using time-dependent modeling approaches.
Methods
Retrospective cohort of kidney transplant recipients. Weekly lymphopenia was classified as absent, transient, or persistent (>2 consecutive weeks). Association with CMV infection was assessed using time-dependent Cox models with patient-clustered robust standard errors (n=202 patients, 39 events, 2,347 person-weeks). Sensitivity analyses included alternative thresholds (lymphocytes <800/μL; persistence ≥3 weeks), 1- and 2-week lagged exposure models, and a simulation of lymphopenia-guided adaptive CMV monitoring.
Results
Persistent lymphopenia was independently associated with CMV infection in both univariable (HR 6.99, 95%CI 2.77–17.66, p<0.001) and multivariable analyses adjusted for sex and induction therapy (HR 5.29, 95%CI 1.77–15.85, p=0.003) [Figure1]. Transient lymphopenia did not reach statistical significance. Sensitivity analyses confirmed robustness (Figure 1B). Lagged models (1- and 2-week lag: HR 6.31 and 3.55, respectively) suggest an anticipatory effect of lymphopenia on subsequent infection risk (Figure 1C). The adaptive monitoring simulation—intensifying virologic surveillance in patients with persistent lymphopenia—detected 87.9% of CMV events while reducing total testing by 33.9% (Figure 1D).
Conclusion
Persistent post-transplant lymphopenia is a dynamic, independent predictor of CMV infection. Integration into adaptive monitoring protocols may optimize virologic surveillance without compromising timely detection in the majority of cases.
Acknowledgment
Ivan Hernandez-Balncas, Daniel Cienfuegos-Ortiz, Georgetthe Estefania Ramos-Vargas with gathering patient information