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

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.