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Opportunistic viral and fungal infections develop in one third of kidney transplant recipients, but they do not affect patient and graft survival, investigators concluded in a study presented at the 2017 American Transplant Congress in Chicago.
In a single-center retrospective review, Michelle L. Lubetzky, MD, and colleagues at Montefiore Medical Center in Bronx, NY, studied 673 kidney transplant recipients. During a median follow-up of 3.8 years, opportunistic infections or malignancy developed in 226 (34%). Of these, 19.8% had BKV, 1.9% had BK nephropathy, 9.6% had cytomegalovirus (CMV), 2.1% had invasive CMV infection, 2.2% had fungal infections, and 5.8% had malignancies. The investigators found no difference in patient or graft survival between the group that experienced opportunistic viral or fungal infections or malignancies and patients without these complications.
A significantly higher percentage of patients with infections or malignancies received decease-donor kidneys than those who did not have these complications (81% vs 74%). The infection/malignancy group were more likely to receive kidneys from older donors (mean age 45.4 vs 42.6 years) and had longer cold ischemia times (1354 vs 1159 minutes) than the group without these complications. The groups showed no significant differences in acute rejection episodes (14% vs 9%), development of recurrent or de novo glomerular disease (8.1% vs 61%), or transplant glomerulopathy (7.6% vs 8.8%), and de novo donor-specific antibodies (17.3% vs 14.7%). The most recent serum creatinine measurements were significantly higher in the infection/malignancy group (1.6 vs 1.5 mg/dL).
Lubetzky M, Hayde N, Kamal L, et al. Prevalence and clinical outcomes in kidney transplant patients with viral and fungal opportunistic infections and malignancy. [abstract] Am J Transplant 2017;17 (suppl 3). Poster presented at the 2017 American Transplant Congress in Chicago, April 29-May 3. Abstract A207.