Risk Factors for CMV and BK Infections in an Elderly Veteran Population Following Kidney Transplantation: Implications for Immunosuppression Induction and Management
Abstract
:1. Introduction
2. Materials and Methods
2.1. Monitoring and Definitions
2.2. Statistical Analyses
3. Results
3.1. Patient Demographics
3.2. Co-Infection
3.3. Transplant Outcomes
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Overall N = 102 | CMV and BKPyV N = 9 | CMV Only N = 28 | BKPyV Only N = 9 | No Infection N = 56 | |
---|---|---|---|---|---|
Age, mean (SD) | 63 (9) | 59 (7) | 63 (9) | 67 (7) | 63 (10) |
Race/ethnicity, n (%) | |||||
African American | 67 (65.7) | 5 (55.6) | 22 (78.6) | 3 (33.3) | 37 (66.1) |
White | 27 (26.5) | 1 (11.1) | 6 (21.4) | 5 (55.6) | 15 (26.8) |
Hispanic | 4 (3.9) | 2 (22.2) | 0 (0.0) | 0 (0.0) | 2 (3.6) |
Other | 4 (3.9) | 1 (11.1) | 0 (0.0) | 1 (11.1) | 2 (3.6) |
Cause of ESRD, n (%) | |||||
Hypertension | 26 (25.5) | 0 (0.0) | 13 (46.4) | 2 (22.2) | 11 (19.6) |
Diabetes | 46 (45.1) | 7 (77.8) | 11 (39.3) | 3 (33.3) | 25 (44.6) |
Other | 30 (29.4) | 2 (22.2) | 4 (14.3) | 4 (44.4) | 20 (35.7) |
Transplant type, n (%) | |||||
DCD | 28 (27.5) | 5 (55.6) | 8 (28.6) | 1 (11.1) | 14 (25.0) |
DDKT | 71 (69.6) | 4 (44.4) | 18 (64.3) | 8 (88.9) | 41 (73.2) |
LRKT | 2 (2.0) | 0 (0.0) | 1 (3.6) | 0 (0.0) | 1 (1.8) |
LUKT | 1 (1.0) | 0 (0.0) | 1 (3.6) | 0 (0.0) | 0 (0.0) |
History of hepatitis C, n (%) | 29 (28.4) | 3 (33.3) | 8 (28.6) | 4 (44.4) | 14 (25.0) |
History of hepatitis B, n (%) | 9 (8.8) | 0 (0.0) | 3 (10.7) | 1 (11.1) | 5 (8.9) |
Immunologic risk, n (%) | 10 (9.8) | 2 (22.2) | 1 (3.6) | 3 (33.3) | 4 (7.1) |
CMV risk, n (%) | |||||
1 | 6 (5.9) | 0 (0.0) | 0 (0.0) | 1 (11.1) | 5 (8.9) |
2 | 48 (47.1) | 5 (55.6) | 12 (42.9) | 4 (44.4) | 27 (48.2) |
3 | 48 (47.1) | 4 (44.4) | 16 (57.1) | 4 (44.4) | 24 (42.9) |
cPRA > 0, n (%) | 8 (7.8) | 3 (33.3) | 1 (3.6) | 1 (11.1) | 3 (5.4) |
Donor age, mean (SD) | 42 (13) | 42 (11) | 44 (12) | 39 (14) | 42 (13) |
KDPI, median (IQR) | 53 (41–75) | 57 (49–80) | 60 (42–84) | 43 (42–67) | 51 (35–68) |
Induction, n (%) | |||||
<4 mg/kg | 31 (30.4) | 4 (44.4) | 9 (32.1) | 1 (11.1) | 17 (30.4) |
>4 mg/kg | 38 (37.3) | 4 (44.4) | 13 (46.4) | 3 (33.3) | 18 (32.1) |
Basiliximab | 33 (32.4) | 1 (11.1) | 6 (21.4) | 5 (55.6) | 21 (37.5) |
Delayed graft function, n (%) | 31 (30.4) | 4 (44.4) | 5 (17.9) | 3 (33.3) | 19 (33.9) |
Death, n (%) | 2 (2.0) | 0 (0.0) | 1 (3.6) | 0 (0.0) | 1 (1.8) |
N | n (%) with CMV | Hazard Ratio (95% Confidence Interval) | p-Value | |
---|---|---|---|---|
Overall | 102 | 37 (36.3) | -- | |
Age, 5-year increase | -- | -- | 0.95 (0.80–1.13) | 0.52 |
Age | ||||
<65 | 54 | 21 (38.9) | 1 (ref) | 0.62 |
≥65 | 48 | 16 (33.3) | 0.85 (0.44–1.62) | |
Race/ethnicity | ||||
African American | 67 | 27 (40.3) | 1 (ref) | 0.58 |
White | 27 | 7 (25.9) | 0.66 (0.27–1.41) | |
Other | 8 | 3 (37.5) | 0.81 (0.22–2.16) | |
Cause of ESRD | ||||
Diabetes | 46 | 18 (39.1) | 1 (ref) | 0.11 |
Hypertension | 26 | 13 (50.0) | 1.30 (0.63–2.60) | |
Other | 30 | 6 (20.0) | 0.50 (0.19–1.16) | |
Transplant type | ||||
DDKT | 28 | 13 (46.4) | 1 (ref) | 0.02 |
DCD | 71 | 22 (31.0) | 1.62 (0.80–3.14) | |
LKT | 3 | 2 (66.7) | 5.07 (1.01–16.3) | |
History of hepatitis C | ||||
No | 73 | 26 (35.6) | 1 (ref) | 0.89 |
Yes | 29 | 11 (37.9) | 0.95 (0.46–1.87) | |
History of hepatitis B | ||||
No | 93 | 34 (36.6) | 1 (ref) | 0.97 |
Yes | 9 | 3 (33.3) | 1.02 (0.28–2.69) | |
Immunologic risk | ||||
No | 92 | 34 (37.0) | 1 (ref) | 0.96 |
Yes | 10 | 3 (30.0) | 0.97 (0.26–2.57) | |
CMV risk | ||||
1 | 6 | 0 (0.0) | 1 (ref) | 0.28 |
2 | 48 | 17 (35.4) | ||
3 | 48 | 20 (41.7) | 1.41 (0.75–2.71) | |
cPRA > 0 | ||||
0 | 94 | 33 (35.1) | 1 (ref) | 0.38 |
>0 | 8 | 4 (50.0) | 1.54 (0.50–3.73) | |
Donor age, 5-year increase | -- | -- | 1.05 (0.93–1.19) | 0.44 |
Donor age | ||||
<40 | 45 | 15 (33.3) | 1 (ref) | 0.56 |
≥40 | 57 | 22 (38.6) | 1.21 (0.64–2.36) | |
KDPI, 10-point increase | -- | -- | 1.10 (0.96–1.27) | 0.17 |
KDPI | ||||
<50 | 45 | 13 (28.9) | 1 (ref) | 0.32 |
≥50 | 54 | 22 (40.7) | 1.40 (0.72–2.83) | |
Induction | ||||
<4 mg/kg | 31 | 13 (41.9) | 1 (ref) | 0.18 |
>4 mg/kg | 38 | 17 (44.7) | 1.06 (0.52–2.20) | |
Basiliximab | 33 | 7 (21.2) | 0.50 (0.19–1.20) | |
Delayed graft function | ||||
No | 71 | 28 (39.4) | 1 (ref) | 0.44 |
Yes | 31 | 9 (29.0) | 0.75 (0.34–1.52) |
N | n (%) with BKPyV | Hazard Ratio (95% Confidence Interval) | p-Value | |
---|---|---|---|---|
Overall | 102 | 18 (17.6) | -- | |
Age, 5-year increase | -- | -- | 1.04 (0.81–1.36) | 0.77 |
Age | ||||
<65 | 54 | 11 (20.4) | 1 (ref) | 0.44 |
≥65 | 48 | 7 (14.6) | 0.69 (0.26–1.76) | |
Race/ethnicity | ||||
African American | 67 | 8 (11.9) | 1 (ref) | 0.03 |
White | 27 | 6 (22.2) | 2.05 (0.67–5.91) | |
Other | 8 | 4 (50.0) | 4.43 (1.18–14.1) | |
Cause of ESRD | ||||
Diabetes | 46 | 10 (21.7) | 1 (ref) | 0.26 |
Hypertension | 26 | 2 (7.7) | 0.30 (0.05–1.16) | |
Other | 30 | 6 (20.0) | 0.91 (0.31–2.46) | |
Transplant type | ||||
DDKT | 71 | 12 (16.9) | 1 (ref) | |
DCD | 28 | 6 (21.4) | 1.21 (0.46–3.16) | 0.88 |
LKT | 3 | 0 (0.0) | -- | |
History of hepatitis C | ||||
No | 73 | 11 (15.1) | 1 (ref) | 0.32 |
Yes | 29 | 7 (24.1) | 1.62 (0.59–4.13) | |
History of hepatitis B | ||||
No | 93 | 17 (18.3) | 1 (ref) | 0.82 |
Yes | 9 | 1 (11.1) | 0.83 (0.09–3.27) | |
Immunologic risk | ||||
No | 92 | 13 (14.1) | 1 (ref) | 0.004 |
Yes | 10 | 5 (50.0) | 4.13 (1.32–11.0) | |
CMV risk | ||||
1 | 6 | 1 (16.7) | 1 (ref) | 0.96 |
2 | 48 | 9 (18.8) | 0.99 (0.19–18.2) | |
3 | 48 | 8 (16.7) | 0.86 (0.16–15.9) | |
cPRA > 0 | ||||
0 | 94 | 14 (14.9) | 1 (ref) | 0.005 |
>0 | 8 | 4 (50.0) | 4.34 (1.23–12.14) | |
Donor age, 5-year increase | -- | -- | 0.94 (0.78–1.13) | 0.53 |
Donor age | ||||
<40 | 45 | 9 (20.0) | 1 (ref) | 0.62 |
≥40 | 57 | 9 (15.8) | 0.79 (0.31–2.03) | |
KDPI, 10-point increase | -- | -- | 1.03 (0.85–1.26) | 0.75 |
KDPI | ||||
<50 | 45 | 8 (17.8) | 1 (ref) | 0.94 |
≥50 | 54 | 10 (18.5) | 1.04 (0.41–2.71) | |
Induction | ||||
<4 mg/kg | 31 | 5 (16.1) | 1 (ref) | 0.97 |
>4 mg/kg | 38 | 7 (18.4) | 1.03 (0.33–3.50) | |
Basiliximab | 33 | 6 (18.2) | 1.14 (0.34–3.97) | |
Delayed graft function | ||||
No | 71 | 11 (15.5) | 1 (ref) | 0.39 |
Yes | 31 | 7 (22.6) | 1.51 (0.56–3.84) |
N | % with Both Infections | Hazard Ratio (95% Confidence Interval) | p-Value | |
---|---|---|---|---|
Overall | 102 | 9 (8.8) | -- | |
Age, 5-year increase | -- | -- | 0.84 (0.60–1.18) | 0.28 |
Age | ||||
<65 | 54 | 8 (14.8) | 1 (ref) | 0.03 |
≥65 | 48 | 1 (2.1) | 0.19 (0.02–0.85) | |
Race/ethnicity | ||||
African American | 67 | 5 (7.5) | 1 (ref) | 0.006 |
White | 27 | 1 (3.7) | 0.72 (0.07–3.59) | |
Other | 8 | 3 (37.5) | 5.09 (1.18–19.1) | |
Cause of ESRD | ||||
Diabetes | 46 | 7 (15.2) | 1 (ref) | 0.08 |
Hypertension | 26 | 0 (0.0) | -- | |
Other | 30 | 2 (6.7) | 0.51 (0.09–1.89) | |
Transplant type | ||||
DDKT | 72 | 7 (9.7) | 1 (ref) | |
DCD | 30 | 2 (6.7) | 3.11 (0.88–11.6) | 0.12 |
LKT | 3 | 0 (0.0) | -- | |
History of hepatitis C | ||||
No | 73 | 6 (8.2) | 1 (ref) | 0.74 |
Yes | 29 | 3 (10.3) | 1.24 (0.29–4.41) | |
History of hepatitis B | ||||
No | 93 | 9 (9.7) | 1 (ref) | 0.63 |
Yes | 9 | 0 (0.0) | -- | |
Immunologic risk | ||||
No | 92 | 7 (7.6) | 1 (ref) | 0.05 |
Yes | 10 | 2 (20.0) | 3.52 (0.65–13.3) | |
CMV risk | ||||
1 | 6 | 0 (0.0) | 1 (ref) | 0.82 |
2 | 48 | 5 (10.4) | ||
3 | 48 | 4 (8.3) | 0.87 (0.23–3.07) | |
cPRA > 0 | ||||
0 | 94 | 6 (6.4) | 1 (ref) | <0.001 |
>0 | 8 | 3 (37.5) | 7.26 (1.72–25.8) | |
Donor age, 5-year increase | -- | -- | 1.00 (0.78–1.29) | 0.97 |
Donor age | ||||
<40 | 45 | 4 (8.9) | 1 (ref) | 0.98 |
≥40 | 57 | 5 (8.8) | 1.01 (0.29–3.78) | |
KDPI, 10-point increase | -- | -- | 1.06 (0.80–1.40) | 0.67 |
KDPI | ||||
<50 | 45 | 3 (6.7) | 1 (ref) | 0.49 |
≥50 | 54 | 6 (11.1) | 1.54 (0.44–6.48) | |
Induction | ||||
<4 mg/kg | 31 | 4 (12.9) | 1 (ref) | 0.40 |
>4 mg/kg | 38 | 4 (10.5) | 0.73 (0.19–2.87) | |
Basiliximab | 33 | 1 (3.0) | 0.32 (0.03–1.74) | |
Delayed graft function | ||||
No | 71 | 5 (7.0) | 1 (ref) | 0.25 |
Yes | 31 | 4 (12.9) | 1.97 (0.53–6.96) |
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Thorndyke, A.; Joyce, C.; Samra, M.; Cotiguala, L.; Trotter, C.; Aguirre, O.; Chon, W.J.; Sodhi, R.; Lopez-Soler, R.I. Risk Factors for CMV and BK Infections in an Elderly Veteran Population Following Kidney Transplantation: Implications for Immunosuppression Induction and Management. Biomedicines 2023, 11, 3060. https://doi.org/10.3390/biomedicines11113060
Thorndyke A, Joyce C, Samra M, Cotiguala L, Trotter C, Aguirre O, Chon WJ, Sodhi R, Lopez-Soler RI. Risk Factors for CMV and BK Infections in an Elderly Veteran Population Following Kidney Transplantation: Implications for Immunosuppression Induction and Management. Biomedicines. 2023; 11(11):3060. https://doi.org/10.3390/biomedicines11113060
Chicago/Turabian StyleThorndyke, Anne, Cara Joyce, Manpreet Samra, Laura Cotiguala, Christine Trotter, Oswaldo Aguirre, W. James Chon, Rupinder Sodhi, and Reynold I. Lopez-Soler. 2023. "Risk Factors for CMV and BK Infections in an Elderly Veteran Population Following Kidney Transplantation: Implications for Immunosuppression Induction and Management" Biomedicines 11, no. 11: 3060. https://doi.org/10.3390/biomedicines11113060