Risk Factors for Breakthrough Cytomegalovirus Infections While on Prophylaxis in Kidney and Pancreas Transplant Recipients

Background: Breakthrough cytomegalovirus (CMV) infection during antiviral prophylaxis may result in significant morbidity. The purpose of this study was to identify the incidence of breakthrough CMV infection and subsequent risk factors in kidney and pancreas transplant recipients on antiviral prophylaxis. Methods: This single-center retrospective cohort study examined 408 adult kidney and/or pancreas transplant episodes from 2018 to 2021 that received CMV antiviral prophylaxis after transplant. Multivariable Cox regression analysis was utilized to explore the association between breakthrough infection and previously identified risk factors, such as delayed graft function (DGF) and rejection. Results: Breakthrough CMV infection occurred in 125/408 (30.8%) of patients. The median time to detection was 30 days after transplant (IQR: 18–50). Those with breakthrough infection had higher incidence of DGF, longer cold ischemic time, and were more commonly deceased donor transplant recipients. Multivariable Cox regression analysis showed DGF was a significant risk factor for breakthrough infection with an HR of 1.68 (95% CI [1.15, 2.45], p < 0.01). Conclusion: Ensuring appropriate dosing of prophylaxis in the setting of DGF may result in decreased risk of breakthrough CMV infection and further complications.

Duke Scholars

Author Lexie Zidanyue Yang  

Author Alaattin Erkanli Biostatistics & Bioinformatics, Division of Biostatistics