Risk of Cytomegalovirus Viremia Following Transplantation of Hepatitis C‐Viremic Donor Kidneys Into Uninfected Recipients: A Multi‐Center Retrospective Cohort Study

TL;DR

This study found no significant increase in cytomegalovirus (CMV) viremia risk in kidney transplant recipients who received organs from Hepatitis C virus (HCV)-positive donors compared to those who received HCV-negative organs.

Contribution

The study provides a large, multi-center analysis of CMV viremia risk in HCV D+/R− kidney transplants, addressing limitations of prior smaller studies.

Findings

CMV viremia occurred in 15% of HCV D+/R− recipients and 11% of HCV D−/R− recipients.

Transplantation with an HCV-RNA+ donor kidney was not significantly associated with higher CMV viremia risk.

Abstract

Several studies have suggested an increased risk of cytomegalovirus (CMV) viremia among Hepatitis C virus (HCV)‐uninfected recipients of kidney transplants from HCV‐RNA+ deceased donors (HCV D+/R−), but these studies featured small sample sizes and limited ability to address confounding variables.

We assembled a retrospective cohort of adult kidney transplant recipients at five US centers between 4/1/2015 and 12/31/2020 to determine the association between HCV D+/R− transplants and the outcomes of CMV viremia (> 1000 IU/mL), death‐censored graft failure, and mortality in the first posttransplant year compared to HCV D−/R− transplants. We generated highly similar matched cohorts of HCV D+/R− and HCV D−/R− recipients based on attributes that affect the risk of CMV viremia. We matched exactly on center, CMV donor/recipient serostatus, and antibody induction therapy.

The cohort comprised 275 HCV D+/R− recipients with a mean age of 52.5 years (SD = 10.7); 19% were CMV D+/R−, and 74% received anti‐thymocyte globulin induction. With variable ratio matching, 267 HCV D+/R− recipients were matched to 996 HCV D−/R− recipients. CMV viremia occurred in 15% of HCV D+/R− and 11% of HCV D−R− recipients. In Cox regression, transplantation with an HCV‐RNA+ donor kidney was not associated with a significantly higher risk of CMV viremia (HR 1.3, 95% CI 0.89–1.92) or death‐censored graft loss (HR 0.61, 95% CI 0.31–1.2).

The risk of CMV viremia was not significantly increased among HCV D+/R− kidney recipients. Future studies should examine associations between donor‐derived HCV infection and clinical outcomes of CMV syndrome and disease.

The risk of CMV viremia was not significantly increased among HCV D+/R− kidney recipients. Future studies should examine associations between donor‐derived HCV infection and clinical outcomes of CMV syndrome and disease.

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