Cytomegalovirus mismatch still negatively affects patient and graft survival in the era of routine prophylactic and preemptive therapy: A paired kidney analysis

Abstract

The impact of cytomegalovirus (CMV) serostatus on kidney transplant outcomes in an era when CMV prophylactic and preemptive strategies are used routinely is not clearly established. Using United Network for Organ Sharing/Organ Procurement and Transplantation Network data, recipients with first deceased donor kidney transplant (≥18 years, 2010-2015) were stratified into 4 groups in the main cohort: CMV-seronegative donor (D−)/CMV-seronegative recipient (R−), CMV-seropositive donor (D+)/R−, D+/CMV-seropositive recipient (R+), and D−/R+. In a paired kidney cohort, we identified 2899 pairs of D− kidney transplant with discordance of recipient serostatus (D−/R− vs D−/R+) and 4567 pairs of D+ kidney transplant with discordance of recipient serostatus (D+/R− vs D+/R+). In the main cohort, D+/R− was associated with a higher risk of graft failure (hazard ratio [HR] = 1.17, P =.01), all-cause mortality (HR = 1.18, P