Simultaneous pancreas/kidney transplant recipients are predisposed to tissue-invasive cytomegalovirus disease and concomitant infectious complications.
BACKGROUND
Infections have increased in simultaneous pancreas/kidney transplant recipients (SPKTRs) with cytomegalovirus (CMV) infection being the most important viral infection with adverse impact on patient and allograft outcomes.


METHODS
We studied all primary SPKTRs and deceased-donor kidney transplant recipients (KTRs) between 2008 and 2015 for the development of CMV infection. A total of 21/62 SPKTRs (33.9%) and 90/335 KTRs (26.9%) were diagnosed with CMV infection. A control group of 41 SPKTRs without CMV infection was used for comparison.


RESULTS
SPKTRs showed an increased incidence of CMV infection compared with KTRs. SPKTRs were more likely to develop CMV disease, CMV pneumonia, recurrent CMV infection, higher initial and peak CMV loads, and more need for intravenous antiviral therapy compared with KTRs (P<.05). High-risk CMV serostatus (D+R-) and 2 HLA-B/-DR mismatches increased the risk of CMV infection in SPKTRs (P<.05). No differences were observed for patient and allograft outcomes (P>.05). SPKTRs with CMV infection were more likely to show concomitant Epstein-Barr virus (EBV) viremia compared with SPKTRs without CMV infection (P<.05). SPKTRs with CMV infection showed higher incidences of concomitant BK polyomavirus-associated nephropathy, EBV viremia, and sepsis compared with KTRs with CMV infection (P<.05).


CONCLUSION
Our results suggest a higher incidence and more severe course of CMV infection in SPKTRs compared with KTRs. The increased incidence of concomitant infectious complications among SPKTRs with CMV infection suggests an overall impaired immunity, and calls for more intense screening.
['Schachtner|Thomas|T|http://orcid.org/0000-0001-5549-4798', 'Zaks|Marina|M|', 'Otto|Natalie M|NM|', 'Kahl|Andreas|A|', 'Reinke|Petra|P|']
D000293:Adolescent D000328:Adult D000890:Anti-Infective Agents D003586:Cytomegalovirus Infections D005260:Female D006801:Humans D007166:Immunosuppressive Agents D016030:Kidney Transplantation D008297:Male D008875:Middle Aged D016035:Pancreas Transplantation D012189:Retrospective Studies D012307:Risk Factors D019562:Viral Load D014766:Viremia D055815:Young Adult
simultaneous pancreas/kidney transplantation kidney transplantation CMV EBV BKV