Evolving trends in immunosuppression use and cytomegalovirus infection risk over the past decade in kidney transplantation

Abstract

AbstractBackgroundThe goal was to determine trends in immunosuppression use and its impact on cytomegalovirus (CMV) outcomes over the past 10 years.MethodsThis was a single‐center longitudinal cohort study of adult kidney recipients transplanted between Jan 2012 and June 2021. Baseline and follow‐up data were gathered via chart abstraction and analyzed using univariate and multivariate analyses.ResultsOf 2392 kidney transplants conducted, 131 patients did not meet inclusion criteria. The mean age was 52 years, 41% were female, 57% were black, and 19% were CMV high‐risk. The use of rabbit anti‐thymocyte globulin (RATG) induction (odds ratio [OR] 1.6, 1.3–2.1), tacrolimus (FK) level >8 ng/mL (OR 1.1, 1.09–1.11), CMV D+/R‐ rates (OR 1.06, 1.02–1.10), white blood cell count <3000 (OR 1.22, 1.18–1.26) and valganciclovir prophylaxis (OR 1.7, 1.6–1.9) have significantly increased over the past 10 years. Rejection rates (OR 0.86, 0.82–0.91) and BK viremia >2000 (OR 0.91, 0.91–0.98) have decreased. RATG induction (adjusted hazard ratio [aHR] 1.35, 1.2–1.5), FK >8 ng/mL (aHR 3.5, 3.2–3.9), Belatacept conversion (aHR 2.5, 2.1–3.1), and rejection (aHR 1.8, 1.6–2.0) were significant risk factors for developing CMV infection, while mycophenolate mofetil <1500 mg (aHR 0.52, 0.47–0.59), mammalian target of rapamycin inhibitor (mTORi) conversion (0.77, 0.56–0.89), cyclosporine‐A conversion (aHR 0.68, 0.56–0.84) were associated with lower risk of CMV infection.ConclusionIncreasing use of potent immunosuppression coupled with higher CMV D+/R‐ F rates may be driving higher rates of CMV infection. Cyclosporine and mTORi conversion appears to be protective against CMV. A more individualized immunosuppression regimen based on infection risk merits consideration. image