You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery II1 Apr 2015MP85-04 PREDICTIVE RISK FACTORS OF POST-TRANSPLANT HIGH-GRADE CMV REACTIVATION IN CMV-SEROPOSITIVE PATIENTS IN THE MODERN IMMUNOSUPPRESSIVE ERA Mitsuru Saito, Shigeru Satoh, Hiroshi Tsuruta, Susumu Akihama, Takamitsu Inoue, Shintaro Narita, Norihiko Tsuchiya, and Tomonori Habuchi Mitsuru SaitoMitsuru Saito More articles by this author , Shigeru SatohShigeru Satoh More articles by this author , Hiroshi TsurutaHiroshi Tsuruta More articles by this author , Susumu AkihamaSusumu Akihama More articles by this author , Takamitsu InoueTakamitsu Inoue More articles by this author , Shintaro NaritaShintaro Narita More articles by this author , Norihiko TsuchiyaNorihiko Tsuchiya More articles by this author , and Tomonori HabuchiTomonori Habuchi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1858AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Cytomegalovirus (CMV) prophylaxis is recommended for CMV-seronegative kidney transplant recipients (R-) receiving the grafts from CMV seropositive donors (D+). Meanwhile, whether R+ patients need universal CMV prophylaxis remains unclear. Most of R+ patients with low-grade CMV reactivation show spontaneous remission without deteriorating the graft function and survival. In addition, valganciclovir (VGCV) possibly causes some adverse effects and GCVresistant CMV. Although targeting CMV prophylaxis to R+ patients is ideal, there are few reports addressing the risk factors of highgrade CMV reactivation in R+ patients in the modern immunosuppressive era. METHODS Since July 2004, consecutive 151 R+ patients who received the kidney from D+ in our hospital were enrolled in this study. No recipients received CMV prophylaxis. The induction immunosuppressive therapy was consisted of tacrolimus, MMF, steroid, and basiliximab. Patients with immunological high risks (ABO-incompatible or donor specific anti-HLA antibody positive) received a single-low dose of rituximab and 3 to 4 sessions of apheresis prior to transplantation. High-grade CMV reactivation was defined as CMV-antigenemia (Ag) positive cells becoming higher than 10/200,000 blood leukocytes during the clinical course. The CMV-Ag level was monitored at 2 to 3-weekly intervals until 6 months, and at monthly intervals from 6 to 12 months post-transplantation. We investigated the predictive risk factors of high-grade CMV reactivation in R+ patients. RESULTS The proportion of high-grade CMV reactivation was 29.8% (45/151) in this series. All patients who developed CMV reactivation were cured by VGCV or GCV successfully without inducing GCV-resistant CMV. Although no significant difference was found in the graft function, the graft survival was significantly shorter in the R+ patients with CMV reactivation than those without (p = 0.019). In multivariate analysis, the pre-transplant low-IgG titer against CMV (p = 0.014), potent immunosuppressive protocol (p = 0.019), and high level of MPA AUC 0-12 at 1 month after transplantation (p = 0.045) were independently associated with the development of high-grade CMV reactivation in R+ patients. CONCLUSIONS The development of high-grade CMV reactivation deteriorated the graft survival in R+ patients in the modern immunosuppressive era. Pre-transplant low-IgG titer against CMV, potent immunosuppressive protocol, and high MPA level were predictive risk factors for the development of high-grade CMV reactivation. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1068 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mitsuru Saito More articles by this author Shigeru Satoh More articles by this author Hiroshi Tsuruta More articles by this author Susumu Akihama More articles by this author Takamitsu Inoue More articles by this author Shintaro Narita More articles by this author Norihiko Tsuchiya More articles by this author Tomonori Habuchi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...