Incidence of cytomegalovirus infection after kidney transplantation in the modern era of immunosuppression: the VINTAGE study

Cytomegalovirus (CMV) infection is a frequent complication following kidney transplantation that affects transplant outcomes. This study aimed to (i) estimate the 12-month cumulative incidence of CMV antigenemia (AG) in adult kidney transplant recipients not receiving antiviral prophylaxis, (ii) identify the risk factors for CMV AG, and (iii) assess the impact of CMV AG on transplant outcomes. This study included 128 living donor kidney recipients (aged ≥20 years) who underwent transplantation between 2012 and 2020. The mean recipient age was 52.8 ± 13.0 years. The overall positive CMV AG rates were 10.9%, 35.9%, 45.3%, 53.1%, and 59.4% (95% confidence interval (CI), 50.9-67.9) at 1, 2, 3, 6, and 12 months posttransplantation, respectively. The 12-month incidence rates in D-/R-, D-/R+, D+/R+, and D+/R - were 0%, 25.0%, 62.2%, and 81.3%, respectively. Multivariable analysis revealed that the risk of CMV AG increased with a stepwise increase in CMV serostatus risk category (hazard ratio (HR), 2.65; 95% CI, 1.66-4.21; <i>p</i> < .001) and recipient age (HR, 1.37 per 10-year increase; 95% CI, 1.14-1.65; <i>p</i> < .001). Positive CMV AG was associated with an increased risk of antibody-mediated rejection (HR, 21.40; 95% CI, 2.59-176.2; <i>p</i> = .005) and lower estimated glomerular filtration rate (<i>p</i> = .026). The risk of CMV AG is highest within the first 3 months posttransplant and persists for approximately 7-8 months in D + recipients. These findings underscore the importance of regular CMV monitoring for at least 6 months posttransplantation, particularly in centers employing preemptive therapy.