SAT-342 CYTOMEGALOVIRUS INFECTION IN KIDNEY TRANSPLANTS RECIPIENTS: EXPERIENCE OF A SINGLE CENTER

Abstract

Cytomegalovirus (CMV) is the most common infection after organ transplantation; it can be a major cause of morbidity, mortality. Optimal prevention, diagnosis, and treatment of active CMV infection enhance transplant outcomes. But, the management of CMV varies considerably among transplant centers. We described the incidence, clinical profile, outcome, and risk factors for the development of CMV infection among renal transplant recipients. We studied kidney transplants recipients admitted for CMV infection from January 1998 to September 2018. CMV infection was present if the patient had positive CMV antigenemia or positive PCR CMV. CMV disease was diagnosed if clinical signs and symptoms are associated with CMV infection. About 48 cases of CMV infection was confirmed in our study. The majority of patients were CMV seropositive recipients from seropositive donors (88,8%). Only 29, 16% of our patients had symptomatic CMV infection and 70, 8% had CMV disease. 52, 1% of our recipients developed CMV infection 2 months post-transplantation. Fever was the most common presenting symptoms (97, 2%) and the most common biological disorder were leukopenia (83,3%). Among the 6 who developed tissue-invasive CMV (13,3%), 3 had CMV pneumonitis, 1 has two recurrent episodes of CMV uveitis for, 1 had colitis, and 1 had macrophage activation syndrome induced by CMV during pregnancy. Risk factors that were statistically significant in the development of CMV disease were as follows: recent rejection treatment (p= 0,021) and HLA mismatch (p=0, 05). For the indirect effect of CMV infection, the most frequent was bacterial and fungal coinfections (33, 35%), then we found, graft dysfunction (25%), acute graft rejection (14, 5%), new-onset post-transplant diabetes (6, 25%), post lymphoproliferative disease (1 case, 2, 2%), and mortality incidence was 20%. The cardiovascular events were significantly associated with CMV infection (p=0.02). We also demonstrate a significant association between CMV infection and long term graft function expressed either as graft dysfunction or graft loss: The DFG was lower in CMV infection group in 6 months, 1 year, 2 years and 10 years. The graft loss was significantly superior in patients with CMV infection/disease than patients without CMV (p= 0,05). CMV infection and CMV disease remain an infectious cause of significant clinical problems, morbidity, and mortality. Despite the absence of prophylaxis, the complications associated with CMV infection are usually not higher than in other countries. However, the use of universal prophylaxis and preemptive therapy remains necessary to reduce the hospitalization rate and consequence of CMV infection.