P-1106. Prevalence and disease burden of human cytomegalovirus infection and disease in kidney transplant patients in Taiwan

TL;DR

This study examines the impact of CMV infection in kidney transplant patients in Taiwan, highlighting the need for improved prevention strategies.

Contribution

The study provides insights into the disease burden of CMV in kidney transplant patients and advocates for universal prophylaxis.

Findings

CMV DNAemia and disease occurred in 3.3% of patients, with higher rates in D+/R- patients.

Neutropenia and leukopenia were more common in D+/R- patients compared to other groups.

Patients with CMV disease had higher readmission rates and medical costs.

Abstract

The human cytomegalovirus (CMV) is a common opportunistic pathogen causing complications in kidney transplant (KT) patients and is associated with poor clinical outcomes. This study assessed the disease burden of CMV infection and disease post-KT in Taiwan.

This non-interventional, retrospective chart review study assessed medical records on KT patients (aged ≥ 20 years) from the National Taiwan University Hospital Integrated Medical Database. Baseline information 1-year prior and up to 2 years post-KT follow-up data (standard of care, complications, healthcare resource utilization) from patients with donor (D)/recipient (R) CMV serostatus D+/R-, D-/R+, or D+/R+ and had their 1st KT between January 2017-July 2022 were analyzed.

A total of 150 patients (D+/R-: 10.7%; D-/R+: 6.7%; D+/R+: 82.7%) were enrolled. The mean age was 50 years and 62.0% were males. The proportion of CMV DNAemia and disease during the 2-year follow-up was 3.3% (n=5) (D+/R-: 6.3%; D-/R+: 0%; D+/R+: 3.2%) and were treated with valganciclovir (n=3) or tazocin (n=1). D+/R- patients were more likely to have leukopenia (37.5%) and neutropenia (12.5%), with the events also observed in D-/R+ (leukopenia: 0%; neutropenia: 10.0%) and D+/R+ (10.5%; 2.4%) patients. Majority used prophylactic valganciclovir (98.4-100%) for a mean duration of 93-185 days. Among patients, 6.3% D+/R- and 2.4% D+/R+ received hyperimmune globulin for CMV therapy, and 1.6% D+/R+ received G-CSF regimen filgrastim. Patients with CMV disease or any post-KT events had higher 30-day readmission rates and medical utilization due to readmission (hospitalization, costs) and outpatient (visits, costs). Patients with only neutropenia had higher 30-day admission rates and frequent outpatient visits.

Post-KT CMV infection/disease, neutropenia and leukopenia events were observed during the 2-year follow-up, with higher incidence rates seen in D+/R-. The study showed that R+ patients still have a risk of CMV reactivation. A universal prophylaxis for all patients, including R+ patients, is crucial to refine CMV management and prevention to reduce post-KT disease burden.

Kai-Ting Chen, PhD, MSD Taiwan: Employment