Probabilistic modeling of cytomegalovirus infection under consensus clinical management guidelines

Transplantation. 2009 Feb 27;87(4):570-7. doi: 10.1097/TP.0b013e3181949e09.


Background: Cytomegalovirus (CMV) is the most common viral pathogen after renal transplantation and remains a major therapeutic challenge with important clinical and economic implications from both direct and indirect consequences of infection.

Methods: This 5-year study modeled the relationship between CMV infection and biopsy-proven graft rejection, graft loss, or death after renal transplantation in an inception cohort using Canadian consensus guidelines for CMV management as a component of a detailed cost-analysis of viral infection.

Results: Probabilities of CMV viremia and syndrome/disease among 270 sequential graft recipients were 0.27 and 0.09, respectively; 91% of cases occurred in the first 6 months. Probability of CMV infection as the first event was 0.29, with a probability of subsequent biopsy-proven acute rejection (BPAR) of 0.05 (mean: 62+/-26 days, range: 32-85 days), whereas the probability of BPAR as the first event was 0.18, with a probability of subsequent CMV infection of 0.38 (mean: 63+/-31, range: 27-119 days). Probability of freedom from both CMV infection and BPAR throughout the period of observation was 0.53. Time-dependent Cox analysis showed that neither donor/recipient CMV risk stratum nor CMV infection influenced the risks of BPAR (P=0.24; P=0.74) or of graft loss or death (P=0.26; P=0.34). In contrast, BPAR significantly increased the risk of both subsequent CMV infection (hazard ratio=1.77, P=0.03) and of graft loss or death (hazard ratio=8.31, P<0.0001).

Conclusions: Although current antiviral therapy seems to mitigate the reported deleterious effects of CMV infection on BPAR or graft survival, BPAR remains a significantly risk factor for both CMV infection and functional graft survival.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antilymphocyte Serum / therapeutic use
  • Antiviral Agents / therapeutic use
  • Biopsy
  • Cytomegalovirus Infections / drug therapy
  • Cytomegalovirus Infections / epidemiology*
  • Cytomegalovirus Infections / pathology
  • Ganciclovir / therapeutic use
  • Graft Rejection / pathology
  • Graft Rejection / virology
  • Histocompatibility Testing
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Kidney Transplantation / adverse effects*
  • Kidney Transplantation / immunology
  • Postoperative Complications / epidemiology
  • Practice Guidelines as Topic
  • Probability
  • Retrospective Studies
  • Risk Assessment
  • T-Lymphocytes / immunology


  • Antilymphocyte Serum
  • Antiviral Agents
  • Immunosuppressive Agents
  • Ganciclovir