# Incidence of Cytomegalovirus (CMV) Infection in After Kidney Transplant Patients: A Systematic Review and Meta‐Analysis

## TL;DR

This study finds that nearly half of kidney transplant patients develop CMV infection, highlighting key risk factors and the need for targeted monitoring.

## Contribution

A systematic review and meta-analysis quantifies CMV incidence and identifies risk factors in kidney transplant recipients.

## Key findings

- The pooled incidence of CMV infection in kidney transplant recipients is 42%.
- Key risk factors include donor-recipient serodiscordance, advanced age, and post-transplant lymphopenia.
- High heterogeneity among studies suggests variability in CMV incidence across populations.

## Abstract

Kidney transplantation is recognised by the World Health Organisation as the most effective therapy for end‐stage renal disease, offering substantial improvements in survival and quality of life. However, the immunosuppression required to prevent graft rejection predisposes recipients to opportunistic infections, among which cytomegalovirus (CMV) remains a leading cause of morbidity and mortality. To determine the incidence of CMV infection in kidney transplant recipients and identify clinical and laboratory predictors and associated risk factors. A systematic review and meta‐analysis, registered in PROSPERO (CRD42024524165), was conducted in accordance with PRISMA guidelines. PubMed, Web of Science, and LILACS databases were searched up to 6 March 2024 for cohort studies reporting CMV incidence post‐kidney transplantation. Methodological quality was assessed using the Newcastle–Ottawa Scale (NOS). Publication bias was evaluated using funnel plots, Egger's test, Kendall's tau, and the fail‐safe N. Fifteen studies met the inclusion criteria, comprising 3888 patients with a mean age of 45.1 years and a mean follow‐up of 7.14 months. The pooled incidence of CMV infection was 42% (95% CI: 30%–54%), with high heterogeneity (I2 = 98.75%; p < 0.001). Sensitivity analysis confirmed the robustness of the results, and no significant publication bias was detected. The main risk factors were: advanced age, paediatric age (< 5 years), donor–recipient serodiscordance (D+/R−), post‐transplant lymphopenia, and reduced cell‐specific immunity defect. CMV infection remains a common and clinically significant complication following kidney transplantation. With a high incidence and strong association with specific laboratory and clinical predictors. Individualised prevention strategies and early virological and immunological monitoring, especially in high‐risk groups, are essential to reduce morbidity and mortality and preserve graft function.

PROSPERO: CRD42024524165