Kidney Donor-Recipient CMV Matching Is a Promising Strategy
The CMV matching strategy decreased the number of D+/R- transplants from 60 (19.1%) to 9 (2.9%).
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Cytomegalovirus (CMV) matching of deceased kidney donors and kidney transplant recipients optimizes high- and low-risk profiles and has the potential to prevent CMV infections and mortality and decrease costs associated with antiviral prophylaxis and treatment, researchers reported at the 2017 American Transplant Congress in Chicago.
Investigators at the Oregon Health and Science University (OHSU) in Portland and the University of Nebraska in Omaha reported on a pre-transplant CMV matching program that went into effect at their institutions on August 1, 2012 whereby deceased kidney donors and kidney recipients are matched by CMV serostatus. The goal is to reduce the number of high-risk donor positive/recipient negative (D+/R-) transplants and increase the number of low-risk donor negative/recipient negative (D-/R-) transplants without adversely affecting wait times for a deceased-donor kidney.
Joseph B. Lockridge, MD, of OHSU, and colleagues retrospectively studied 622 deceased-donor kidney transplant recipients: 314 pre-CMV matching and 308 post-CMV matching. The CMV matching strategy decreased the number of D+/R- transplants from 60 (19.1%) to 9 (2.9%) and increased the number of D-/R- transplants from 42 (13.4%) to 74 (24%), Dr Lockridge and his colleagues reported. The changes from before and after imposition of CMV matching were statistically significant.
Before and after intervention, the median number of days on the wait list increased from 651 to 853. The median number of days on the wait list increased from 696 to 862 for CMV negative recipients and from 611 to 843 for CMV positive recipients.
“Not surprisingly, median waiting times for a kidney transplant increased for all patients during this study due to growing waiting list size, but neither CMV negative nor CMV positive patients appeared to be disadvantaged by implementing CMV matching,” the investigators wrote in their study abstract.
In a separate analysis comparing 197 pre-CMV matching and 159 post-CMV matching recipients, the researchers demonstrated that the CMV matching has the potential to significantly improve CMV-related morbidity and associated costs. CMV viremia rates decreased from 14.2% to 6.3% after implementing CMV matching. The percentage of patients requiring antiviral treatment for CMV decreased from 11.2% to 5.7%. In a randomly sampled comparison between 10 high CMV risk transplant recipients and 10 low CMV risk transplant recipients, the investigators found that the median cost associated with antiviral prophylaxis and therapy was $27,173 in the high-risk group compared with $16 in the low-risk group.
Lockridge J. Langewisch E. Basuli D, et al. Kidney allocation using CMV matching optimizes low and high risk profiles for prevention of CMV infection in kidney transplant recipients.[abstract]. Am J Transplant 2017;17 (suppl 3). Poster presented at the 2017 American Transplant Congress in Chicago, April 29-May 3. Abstract A192
Lockridge J. Langewisch E. Basuli D, et al. Kidney transplant allocation with CMV matching reduces CMV infection and related costs.[abstract]. Am J Transplant 2017;17 (suppl 3). Poster presented at the 2017 American Transplant Congress in Chicago, April 29-May 3. Abstract A190