AccScience Publishing / JCTR / Online First / DOI: 10.36922/jctr.24.00067
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ORIGINAL ARTICLE

Secular trends in cytomegalovirus risk and outcomes by race: A 10-year longitudinal study in adult kidney transplant recipients

Karim Soliman1,2,3 ,  Ahmed Daoud2,3 ,  Amy Perry1* ,  Morgan Overstreet3 ,  Erika Andrade3 ,  Isabel K. Calimlim3 ,  Courtney E. Harris4 ,  David J. Taber3,5
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1 Department of Medicine Service, Ralph H. Johnson VA Healthcare System, Charleston, South Carolina, United States of America
2 Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, South Carolina, United States of America
3 Department of Surgery, Division of Transplant Surgery, Medical University of South Carolina, South Carolina, United States of America
4 Department of Medicine, Division of Infectious Diseases, Medical University of South Carolina, South Carolina, United States of America
5 Department of Pharmacy Service, Ralph H. Johnson VA Healthcare System, Charleston, South Carolina, United States of America
JCTR, 00067 https://doi.org/10.36922/jctr.24.00067
Submitted: 14 October 2024 | Revised: 9 December 2024 | Accepted: 20 February 2025 | Published: 20 March 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Background and aim: Cytomegalovirus (CMV) remains a critical post-transplant opportunistic infection despite significant advancements in monitoring and therapy. The impact of African-American (AA) race on CMV risk and outcomes has been insufficiently studied. This study aimed to determine secular trends in the incidence of CMV D+/R− mismatching and evaluate their association with AA race and clinical outcomes. Methods: This single-center longitudinal cohort study involved adult kidney recipients transplanted between January 2012 and June 2021, with follow-up through June 2022. Univariate and multivariate statistics were performed to analyze the data. Results: Of 2392 kidney transplant recipients, 2,261 were included in the final analysis after applying exclusion criteria. The mean age was 52 years, 41% were female, and 57% were black. In addition, 19% were classified as CMV high-risk. Secular trend analysis revealed an increase in CMV D+/R− rates over time. AAs had 51% lower odds of being CMV D+/R− (p<0.001), which remained stable over the study period (p=0.80). In adjusted models, AAs had a 50% higher risk of developing CMV infection (Hazard ratio [HR] = 1.49, confidence interval [CI]: 1.1 – 2.0) and late CMV infection (HR = 1.5, CI: 1.03 – 2.3), with no significant change over time (p>0.20). AA race was also a risk factor for acute rejection and death-censored graft loss, with no notable changes observed over the study period. Conclusion: In kidney transplant recipients, the incidence of CMV D+/R− serostatus has increased over the past decade. AAs are 50% less likely to be CMV D+/R− but have higher normalized rates of other complications, which remained relatively stable over the study period. Future studies should explore the underlying mechanisms contributing to the higher rates of CMV infection in AAs, which could facilitate the development of targeted interventions. Factors such as immunosenescence and genetic polymorphisms warrant further exploration. Relevance for patients: CMV risk, outcomes, racial disparities in kidney transplant.

Keywords
Cytomegalovirus
Kidney transplant
Racial disparities
Outcomes
Immunosuppression
Infections
Funding
Research presented in this manuscript was conducted through the support of a grant provided by Merck Pharmaceuticals.
Conflict of interest
David J Taber reports financial support was provided by Merck & Co Inc. David J Taber reports a relationship with Veloxis Pharmaceuticals Inc., that includes board membership and funding grants. David J Taber reports a relationship with CareDx Inc., that includes board membership and funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
References
  1. Suthanthiran M, Strom TB. Renal transplantation. N Engl J Med. 1994;331(6):365-376. doi: 10.1056/NEJM199408113310606

 

  1. Wolfe RA, Ashby VB, Milford EL, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999;341(23):1725-1730. doi: 10.1056/NEJM199912023412303

 

  1. Szumilas K, Wilk A, Wiśniewski P, et al. Current status regarding immunosuppressive treatment in patients after renal transplantation. Int J Mol Sci. 2023;24(12):10301. doi: 10.3390/ijms241210301

 

  1. Agrawal A, Ison MG, Danziger-Isakov L. Long-term infectious complications of kidney transplantation. Clin J Am Soc Nephrol. 2022;17(2):286-295. doi: 10.2215/CJN.15971020

 

  1. Kasiske BL, Zeier MG, Chapman JR, et al. KDIGO clinical practice guideline for the care of kidney transplant recipients: A summary. Kidney Int. 2010;77(4):299-311.

 

  1. Kuo HT, Ye X, Sampaio MS, Reddy P, Bunnapradist S. Cytomegalovirus serostatus pairing and deceased donor kidney transplant outcomes in adult recipients with antiviral prophylaxis. Transplantation. 2010;90(10):1091-1098. doi: 10.1097/TP.0b013e3181f7c053

 

  1. Patzer RE, McClellan WM. Influence of race, ethnicity and socioeconomic status on kidney disease. Nat Rev Nephrol. 2012;8(9):533-541. doi: 10.1038/nrneph.2012.117

 

  1. Ciancio G, Burke GW, Suzart K, et al. The use of daclizumab, tacrolimus and mycophenolate mofetil in african-american and Hispanic first renal transplant recipients. Am J Transplant. 2003;3(8):1010-1016. doi: 10.1034/j.1600-6143.2003.00181.x

 

  1. Neylan JF. Racial differences in renal transplantation after immunosuppression with tacrolimus versus cyclosporine. FK506 Kidney Transplant Study Group. Transplantation. 1998;65(4):515-523. doi: 10.1097/00007890-199802270-00011

 

  1. Podder H, Podbielski J, Hussein I, Katz S, Van Buren C, Kahan BD. Sirolimus improves the two-year outcome of renal allografts in African-American patients. Transpl Int. 2001;14(3):135-142. doi: 10.1007/s001470100315

 

  1. Weber M, Deng S, Arenas J, et al. Decreased rejection episodes in African-American renal transplant recipients receiving mycophenolate mofetil/tacrolimus therapy. Transplant Proc. 1997;29(8):3669-3670. doi: 10.1016/s0041-1345(97)01067-1

 

  1. Branson RD, Davis K Jr., Butler KL. African Americans’ participation in clinical research: Importance, barriers, and solutions. Am J Surg. 2007;193(1):32-39, discussion 40. doi: 10.1016/j.amjsurg.2005.11.007

 

  1. Lantos PM, Permar SR, Hoffman K, Swamy GK. The excess burden of cytomegalovirus in African American communities: A geospatial analysis. Open Forum Infect Dis. 2015;2(4):ofv180. doi: 10.1093/ofid/ofv180

 

  1. Zuhair M, Smit GSA, Wallis G, et al. Estimation of the worldwide seroprevalence of cytomegalovirus: A systematic review and meta-analysis. Rev Med Virol. 2019;29(3):e2034. doi: 10.1002/rmv.2034

 

  1. Gruber SA, Garnick J, Morawski K, et al. Cytomegalovirus prophylaxis with valganciclovir in African-American renal allograft recipients based on donor/recipient serostatus. Clin Transplant. 2005;19(2):273-278. doi: 10.1111/j.1399-0012.2005.00337.x

 

  1. Taber DJ, Gebregziabher M, Hunt KJ, et al. Twenty years of evolving trends in racial disparities for adult kidney transplant recipients. Kidney Int. 2016;90(4):878-887. doi: 10.1016/j.kint.2016.06.029

 

  1. Purnell TS, Luo X, Kucirka LM, et al. Reduced racial disparity in kidney transplant outcomes in the United States from 1990 to 2012. J Am Soc Nephrol. 2016;27(8): 2511-2518. doi: 10.1681/ASN.2015030293

 

  1. Hart A, Smith JM, Skeans MA, et al. OPTN/SRTR 2017 annual data report: Kidney. Am J Transplant. 2019;19(Suppl 2): 19-123. doi: 10.1111/ajt.15274

 

  1. Patzer RE, Gander J, Sauls L, et al. The RaDIANT community study protocol: Community-based participatory research for reducing disparities in access to kidney transplantation. BMC Nephrol. 2014;15:171. doi: 10.1186/1471-2369-15-171

 

  1. White NH, Yow MD, Demmler GJ, et al. Prevalence of cytomegalovirus antibody in subjects between the ages of 6 and 22 years. J Infect Dis. 1989l;159(6):1013-1017. doi: 10.1093/infdis/159.6.1013

 

  1. Helanterä I, Kyllönen L, Lautenschlager I, Salmela K, Koskinen P. Primary CMV infections are common in kidney transplant recipients after 6 months valganciclovir prophylaxis. Am J Transplant. 2010;10(9):2026-2032. doi: 10.1111/j.1600-6143.2010.03225.x

 

  1. Staras SA, Dollard SC, Radford KW, Flanders WD, Pass RF, Cannon MJ. Seroprevalence of cytomegalovirus infection in the United States, 1988-1994. Clin Infect Dis. 2006;43(9):1143-1151. doi: 10.1086/508173

 

  1. Isaacs RB, Nock SL, Spencer CE, et al. Racial disparities in renal transplant outcomes. Am J Kidney Dis. 1999;34(4):706-712. doi: 10.1016/S0272-6386(99)70397-5

 

  1. Williams A, Richardson C, McCready J, et al. Black ethnicity is not a risk factor for mortality or graft loss after kidney transplant in the United Kingdom. Exp Clin Transplant. 2018;16(6):682-689. doi: 10.6002/ect.2018.0241

 

  1. Harding K, Mersha TB, Pham PT, et al. Health disparities in kidney transplantation for African Americans. Am J Nephrol. 2017;46(2):165-175. doi: 10.1159/000479480

 

  1. Limaye AP, Budde K, Humar A, et al. Letermovir vs valganciclovir for prophylaxis of cytomegalovirus in high-risk kidney transplant recipients: A randomized clinical trial. JAMA. 2023;330(1):33-42. doi: 10.1001/jama.2023.9106

 

  1. Raglow Z, Kaul DR. A new antiviral option for cytomegalovirus prevention after kidney transplant. JAMA. 2023;330(1):27-29. doi: 10.1001/jama.2023.9100

 

  1. Brum S, Nolasco F, Sousa J, et al. Leukopenia in kidney transplant patients with the association of valganciclovir and mycophenolate mofetil. Transplant Proc. 2008;40(3): 752-754. doi: 10.1016/j.transproceed.2008.02.048

 

  1. Lentine KL, Smith JM, Miller JM, et al. OPTN/SRTR 2021 annual data report: Kidney. Am J Transplant. 2023;23(2 Suppl 1):S21-S120. doi: 10.1016/j.ajt.2023.02.004

 

  1. Moayedi Y, Fan CS, Miller RJ. Gene expression profiling and racial disparities in outcomes after heart transplantation. J Heart Lung Transplant. 2019;38(8):820-829. doi: 10.1016/j.healun.2019.05.008

 

  1. Müller L, Di Benedetto S. Immunosenescence and cytomegalovirus: Exploring their connection in the context of aging, health, and disease. Int J Mol Sci. 2024;25(2):753. doi: 10.3390/ijms25020753
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Journal of Clinical and Translational Research, Electronic ISSN: 2424-810X Print ISSN: 2382-6533, Published by AccScience Publishing
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